Provider Demographics
NPI:1184194029
Name:CONVERSE, STEPHANIE LUCILLE (APRN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LUCILLE
Last Name:CONVERSE
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 1:326 LEE RD # 601
Mailing Address - Street 2:
Mailing Address - City:BRICKEYS
Mailing Address - State:AR
Mailing Address - Zip Code:72320-8000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:326 LEE RD # 601
Practice Address - Street 2:
Practice Address - City:BRICKEYS
Practice Address - State:AR
Practice Address - Zip Code:72320-8000
Practice Address - Country:US
Practice Address - Phone:870-295-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005565363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care