Phillips, Stacey Michele

Phillips, Stacey Michele is an individual health care provider with primary practice located at 46 W Colt Square Dr , Fayetteville AR 72703-2813. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics, which is considered as her primary health care specialty. Phillips, Stacey Michele can be contacted via phone (479) 582-2740.

Contact Information

Primary practice address
46 W Colt Square Dr Fayetteville AR 72703-2813
Phone: (479) 582-2740
Fax: (479) 582-2746
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics 2251P0200X PT 2212 Arkansas

Profile Details

NPI number 1053558494
LBN Legal business name Phillips, Stacey Michele
Credentials MS, PT
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 7th, 2009
Last updated Jan 7th, 2009 - about 16 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 1053558494 NPPES
Arkansas MEDICAID 135927721

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