Provider Demographics
NPI:1407552557
Name:STEWART, REBECCA ELLEN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ELLEN
Last Name:STEWART
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 ARCADIA DR
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3534
Mailing Address - Country:US
Mailing Address - Phone:479-616-0690
Mailing Address - Fax:
Practice Address - Street 1:2108 S 54TH ST STE 1
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8125
Practice Address - Country:US
Practice Address - Phone:479-396-5200
Practice Address - Fax:833-963-1060
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR041145163WE0003X, 163W00000X, 163WW0000X
AR222391363L00000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163W00000XNursing Service ProvidersRegistered Nurse
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily