Individual
STEPHANIE L WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1477 HIGHWAY 167, EVENING SHADE, AR 72532-9497
(870) 283-2554
Mailing address
1477 HIGHWAY 167, EVENING SHADE, AR 72532-9497
(870) 283-2554
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
214600
AR
Other
Enumeration date
03/04/2021
Last updated
03/04/2021
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