Provider Demographics
NPI:1326536681
Name:LUNDRY, STELLA MICHELLE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:MICHELLE
Last Name:LUNDRY
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:LUNDRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2500 BRITTON DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-8544
Mailing Address - Country:US
Mailing Address - Phone:870-243-0938
Mailing Address - Fax:
Practice Address - Street 1:225 E JACKSON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3119
Practice Address - Country:US
Practice Address - Phone:870-207-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005615363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care