Individual
STEFANIE A ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
2800 FAYETTEVILLE RD, VAN BUREN, AR 72956-6523
(479) 314-4000
(479) 314-4050
Mailing address
5401 ELLSWORTH RD, FORT SMITH, AR 72903-3219
(479) 314-1101
(479) 314-4704
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A01792
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154409758
—
AR
05
—
200041860A
—
OK
01
—
5X925
AR BCBS
AR
Enumeration date
07/18/2006
Last updated
04/01/2011
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