Provider Demographics
NPI:1659345247
Name:HOPPER, STACI L (APN)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:L
Last Name:HOPPER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:L
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:2708 RIFE MEDICAL LN STE 200
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1452
Mailing Address - Country:US
Mailing Address - Phone:479-338-3080
Mailing Address - Fax:479-338-3089
Practice Address - Street 1:2708 RIFE MEDICAL LN STE 200
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1452
Practice Address - Country:US
Practice Address - Phone:479-338-3080
Practice Address - Fax:479-338-3089
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00421524OtherRR MCR
AR158379758Medicaid
OK200074830AMedicaid
Q55883Medicare UPIN
AR5Y563Medicare PIN