Provider Demographics
NPI:1467896886
Name:RESCHKE, STACY CARMEN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:CARMEN
Last Name:RESCHKE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 STATE HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-9004
Mailing Address - Country:US
Mailing Address - Phone:870-739-8670
Mailing Address - Fax:870-739-8706
Practice Address - Street 1:924 STATE HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-9004
Practice Address - Country:US
Practice Address - Phone:870-739-8670
Practice Address - Fax:870-739-8706
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17578363LF0000X
ARA004774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR214841758Medicaid