Individual
MRS. STACI DIANN CLOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
705 SANTA FE DR, SEARCY, AR 72143-6964
(501) 268-3853
Mailing address
155 KEITH RD, SEARCY, AR 72143-9219
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
P-T1107
AR
Other
Enumeration date
02/16/2011
Last updated
02/16/2011
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