Provider Demographics
NPI:1578980595
Name:STAHLEY, CYNTHIA DIANNE (APRN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DIANNE
Last Name:STAHLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:DIANNE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:DERMOTT
Mailing Address - State:AR
Mailing Address - Zip Code:71638-0509
Mailing Address - Country:US
Mailing Address - Phone:870-538-5414
Mailing Address - Fax:
Practice Address - Street 1:1109 CUB DRIVE
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:AR
Practice Address - Zip Code:71646
Practice Address - Country:US
Practice Address - Phone:870-224-0116
Practice Address - Fax:877-751-3582
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA004061OtherA004061