Provider Demographics
NPI:1619297801
Name:METCALF, STEPHANIE (APN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:METCALF
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-4432
Mailing Address - Country:US
Mailing Address - Phone:479-705-8181
Mailing Address - Fax:479-705-0041
Practice Address - Street 1:25 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4432
Practice Address - Country:US
Practice Address - Phone:479-705-8181
Practice Address - Fax:479-705-0041
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003339363L00000X
ARA03339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA03339OtherLICENSE