STEPHANIE BOHANNON


Address: 112 W Center St Ste 201, Fayetteville, AR 72701-6073
Phone: 4793167770

STEPHANIE BOHANNON (NPI# 1104459114) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1104459114
Entity Type Individual
Full Name STEPHANIE BOHANNON
Other Name STEPHANIE PARKER
Credential PMHNP, APRN
Practice Address 112 W Center St Ste 201
Fayetteville
AR 72701-6073
Mailing Address 4517 W Divide Dr
Fayetteville
AR 72704-4020
Practice Telephone 4793167770
Mailing Telephone 4793015550
Enumeration Date 2020-02-18
Last Update Date 2020-02-18
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
124030 AR Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 112 W CENTER ST STE 201
City FAYETTEVILLE
State AR
Zip Code 72701-6073

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Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

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Competitor

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City FAYETTEVILLE
Zip Code 72701

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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