Provider Demographics
NPI:1306072152
Name:ENLOW, STACEY LYNN (APN)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:ENLOW
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N HICO ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-2810
Mailing Address - Country:US
Mailing Address - Phone:479-238-1222
Mailing Address - Fax:479-238-1229
Practice Address - Street 1:450 N HICO ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-2810
Practice Address - Country:US
Practice Address - Phone:479-238-1222
Practice Address - Fax:479-238-1229
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily