Provider Demographics
NPI:1093254294
Name:MIRANDA, CATHERINE STEPHANIE (CNP, FNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:STEPHANIE
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:CNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N MCCONNELL ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830
Mailing Address - Country:US
Mailing Address - Phone:479-479-7338
Mailing Address - Fax:479-440-8198
Practice Address - Street 1:120 N MCCONNELL ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-3523
Practice Address - Country:US
Practice Address - Phone:479-440-8197
Practice Address - Fax:479-440-8198
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily