Provider Demographics
NPI:1609185586
Name:MALLETT, STEPHANIE L (APRN)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:L
Last Name:MALLETT
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 1:520 N PINE ST STE B
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3442
Mailing Address - Country:US
Mailing Address - Phone:870-741-0249
Mailing Address - Fax:870-741-0383
Practice Address - Street 1:520 N PINE ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3442
Practice Address - Country:US
Practice Address - Phone:870-741-0249
Practice Address - Fax:870-741-0383
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily