Provider Demographics
NPI:1790815819
Name:STEVENS, AMY LOUISE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LOUISE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:LOUISE
Other - Last Name:STEELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 NORTH 18.5 AVENUE
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450
Mailing Address - Country:US
Mailing Address - Phone:870-236-9358
Mailing Address - Fax:
Practice Address - Street 1:1910 MOCKINGBIRD LN
Practice Address - Street 2:SUITE B & C
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5806
Practice Address - Country:US
Practice Address - Phone:870-240-0671
Practice Address - Fax:870-240-0514
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL42417164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse