Provider Demographics
NPI:1093218042
Name:NORTH-FLANAGAN, STACY L (APRN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:NORTH-FLANAGAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 FORT ST
Mailing Address - Street 2:
Mailing Address - City:BARLING
Mailing Address - State:AR
Mailing Address - Zip Code:72923-2013
Mailing Address - Country:US
Mailing Address - Phone:479-782-0244
Mailing Address - Fax:
Practice Address - Street 1:1420 S I ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901
Practice Address - Country:US
Practice Address - Phone:479-784-0990
Practice Address - Fax:479-784-0948
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005574363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology