Provider Demographics
NPI:1134356942
Name:HARRIS, STACY (APN)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:HARRIS
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 1:525 WESTERN AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4981
Mailing Address - Country:US
Mailing Address - Phone:501-327-7555
Mailing Address - Fax:501-327-9466
Practice Address - Street 1:525 WESTERN AVE STE 304
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4981
Practice Address - Country:US
Practice Address - Phone:501-327-7555
Practice Address - Fax:501-327-9466
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03027363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health