Individual
STEPHANIE L BOHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP, APRN
Contact information
Practice address
2566 E JOYCE BLVD STE 2, FAYETTEVILLE, AR 72703-3923
(479) 935-1000
(479) 935-9200
Mailing address
2566 E JOYCE BLVD STE 2, FAYETTEVILLE, AR 72703-3923
(479) 935-1000
(417) 350-1935
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
124030
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
259152758
—
AR
05
—
420098635
—
MO
Enumeration date
02/18/2020
Last updated
09/21/2022
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