Stephanie L Bohannon, PMHNP, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

124030 Issued in AR

Practice address

2566 E Joyce Blvd Ste 2
Fayetteville, AR 72703-3923

Phone

(479) 935-1000

Fax

(479) 935-9200

NPI assigned

Feb 18, 2020

Last updated

Sep 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Stephanie L Parker Former name

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of South Alabama College of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Reding and Leach MD PLLCGroup PAC ID 7012258627, 62 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: stephanie.bohannon.1@21565.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Reding & Leach MD PLLC

  • Psychiatry Physician
  • Little Rock, AR
  • NPI 1245723584
  Medicare reassignment Care Compare group NPD
• Wellness & Courage

  • Mental Health Counselor
  • Fayetteville, AR
  • NPI 1629546510
  NPD (past)
• Eustasis Foundation, Inc

  • Voluntary or Charitable Agency
  • Springfield, MO
  • NPI 1386257780
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1104459114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2566 E JOYCE BLVD STE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033923",
            "telephone_number": "479-935-1000",
            "fax_number": "417-350-1935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2566 E JOYCE BLVD STE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033923",
            "telephone_number": "479-935-1000",
            "fax_number": "479-935-9200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105 N Mill Ave",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "727014273",
            "country_code": "US",
            "telephone_number": "479-713-8350",
            "fax_number": "479-713-8375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOHANNON",
        "first_name": "STEPHANIE",
        "middle_name": "L",
        "credential": "PMHNP, APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-18",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AR",
            "license": "124030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "PARKER",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christopher Anthony Blum, DO
• Benjamin D Boatwright, BS, QBHP
• Body Mechanix LLC
• Boeckmann Behavioral Services LLC
• Boris V Bogomilov, MD
• Hannah Elizabeth Bohl, PT, DPT
• Bold Dental Partners PLLC
• Michael A Bolding, D.O.
• Taruna Sharma Bolding, D.D.S.
• Marshall A Bolen

• Psychiatric/Mental Health Nurse Practitioner in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.