# STEPHANIE L BOHANNON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1104459114
- **Gender:** F
- **Credential:** PMHNP, APRN

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 124030 | AR | Yes |

## Other

- **Enumeration date:** 02/18/2020
- **Last updated:** 09/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 259152758 | — | AR |
| 05 | — | 420098635 | — | MO |