Bohannon, Stephanie L

Bohannon, Stephanie L is an individual health care provider with primary practice located at 2566 E Joyce Blvd Ste 2 , Fayetteville AR 72703-3923. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Bohannon, Stephanie L can be contacted via phone (479) 935-1000.

Contact Information

Primary practice address
2566 E Joyce Blvd Ste 2 Fayetteville AR 72703-3923
Phone: (479) 935-1000
Fax: (479) 935-9200
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 124030 Arkansas

Profile Details

NPI number 1104459114
LBN Legal business name Bohannon, Stephanie L
Credentials PMHNP, APRN
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 18th, 2020
Last updated Sep 21st, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104459114 NPPES
Arkansas MEDICAID 259152758
Arkansas MEDICAID 420098635

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