Provider Demographics
NPI:1891003828
Name:JOHNSON, STEPHANIE NICOLE (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 SALEM RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7525
Mailing Address - Country:US
Mailing Address - Phone:501-336-8300
Mailing Address - Fax:501-329-5508
Practice Address - Street 1:350 SALEM RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7525
Practice Address - Country:US
Practice Address - Phone:501-336-8300
Practice Address - Fax:501-329-5508
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator