Provider Demographics
NPI:1063102994
Name:BURKS, STEPHANIE (FNP-CNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BURKS
Suffix:
Gender:F
Credentials:FNP-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S THOMPSON ST STE 4A
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4261
Mailing Address - Country:US
Mailing Address - Phone:479-445-9900
Mailing Address - Fax:
Practice Address - Street 1:210 S THOMPSON ST STE 4A
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4261
Practice Address - Country:US
Practice Address - Phone:479-445-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR224158363LF0000X, 207VG0400X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology