Organization
INDEPENDENCE ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN STALKER NP (OWNER)
(870) 613-8390
Entity
Organization
Contact information
Practice address
1710 MAYFIELD DR, JONESBORO, AR 72401-4563
(870) 613-8390
Mailing address
PO BOX 3283, BATESVILLE, AR 72503-3283
(870) 613-8390
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CO1386
STATE LICENSE
AR
Enumeration date
10/02/2020
Last updated
03/07/2022
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