Provider Demographics
NPI:1750705513
Name:LYNCH, STACEY OGLETREE (PMHNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:OGLETREE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:DANIELLE
Other - Last Name:OGLETREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1150 E MATTHEWS AVE STE 101A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4356
Mailing Address - Country:US
Mailing Address - Phone:870-243-0424
Mailing Address - Fax:534-248-4225
Practice Address - Street 1:1150 E MATTHEWS AVE STE 101A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4356
Practice Address - Country:US
Practice Address - Phone:870-243-0424
Practice Address - Fax:534-248-4225
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005293363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health