Provider Demographics
NPI:1710513924
Name:STEPHANIE BURNETT APRN, PLLC
Entity Type:Organization
Organization Name:STEPHANIE BURNETT APRN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:501-765-8390
Mailing Address - Street 1:21415 CHISM DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-9705
Mailing Address - Country:US
Mailing Address - Phone:501-765-8390
Mailing Address - Fax:501-286-6046
Practice Address - Street 1:2796 S 2ND ST STE E
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7043
Practice Address - Country:US
Practice Address - Phone:501-286-6086
Practice Address - Fax:501-286-6046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty