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NPI Code Detail

MEDICARE: MRS. STEPHANIE ANN DAVIS FNP

MEDICARE: MRS. STEPHANIE ANN DAVIS FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAR1162AR

General Provider Information

NPI Number : 1457544934
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STEPHANIE ANN DAVIS FNP
Provider Business Mailing Address
First Line : 620 BROADWAY ST
Second Line :
City : VAN BUREN
State : AR
Zip : 72956-5830
Country : US
Telephone Number : 479-474-5061
Fax Number :
Provider Business Practice Location Address
First Line : 620 BROADWAY ST
Second Line :
City : VAN BUREN
State : AR
Zip : 72956-5830
Country : US
Telephone Number : 479-474-5061
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2007
Last Update Date : 08/09/2012

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