Stephanie L Bohannon, PMHNP, APRN
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Fayetteville, AR
NPI 1104459114 · NPPES record last updated Sep 21, 2022
Key facts
- NPI
- 1104459114
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 124030 (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
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- 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 PLLC
Practice addresses (Care Compare)
11501 Huron LN
Suite 5
Little Rock, AR 72211-2491
Phone (501) 904-4762
2566 E Joyce Blvd
Suite 2
Fayetteville, AR 72703-3923
Phone (479) 935-1000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201229000043 | AR | Practitioner - Nurse Practitioner | 5496168031 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reding & Leach MD PLLC | Current |
Accepting new patients | |
| Wellness & Courage | Past |
Accepting new patients | |
| Eustasis Foundation, Inc | Past |
Accepting new patients |
Locations
2566 E Joyce Blvd
Ste 2
Fayetteville, AR 72703
Phone (479) 935-1000
1150 E Matthews Ave
Ste 1B
Jonesboro, AR 72401
Phone (870) 277-0946
11501 Huron Ln
Ste 5
Little Rock, AR 72211
Phone (501) 904-4762
5305 W Village Pkwy
Ste 12
Rogers, AR 72758
Phone (479) 405-4015
Interoperability endpoints
- stephanie.bohannon.1@21565.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 124030 | AR | Yes |
Addresses
Primary practice location
2566 E Joyce Blvd Ste 2
Fayetteville, AR 72703-3923
Mailing address
2566 E Joyce Blvd Ste 2
Fayetteville, AR 72703-3923
Phone (479) 935-1000
Other practice location 1
105 N Mill Ave
Fayetteville, AR 72701-4273
Phone (479) 713-8350
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 259152758 | Medicaid | AR | |
| 420098635 | Medicaid | MO |
Other names
- Stephanie L Parker
Other providers in Fayetteville, AR
- Christopher Anthony Blum
- Benjamin D Boatwright
- Body Mechanix LLC
- Boeckmann Behavioral Services LLC
- Boris V Bogomilov
- Hannah Elizabeth Bohl
- Bold Dental Partners PLLC
- Michael A Bolding
- Taruna Sharma Bolding
- Marshall A Bolen
All providers in Fayetteville, AR · Psychiatric/Mental Health Nurse Practitioner in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.