Provider Demographics
NPI:1164536926
Name:STILES, ROSEMARY (APN)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:STILES
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W DREW STREET
Mailing Address - Street 2:
Mailing Address - City:MONETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72447
Mailing Address - Country:US
Mailing Address - Phone:870-486-5464
Mailing Address - Fax:870-486-2118
Practice Address - Street 1:210 W DREW STREET
Practice Address - Street 2:
Practice Address - City:MONETTE
Practice Address - State:AR
Practice Address - Zip Code:72447
Practice Address - Country:US
Practice Address - Phone:870-486-5464
Practice Address - Fax:870-486-2118
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01230363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARS27098Medicare UPIN
AR5T361Medicare ID - Type UnspecifiedMEDICARE NUMBER