Active NPI
Stacie Michelle Cornwell, MSED
- Developmental Therapist
- Benton, AR
National Provider Identifier
1255868774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 1306 Military Rd Ste 1
Benton, AR 72015-2732 - Phone
- (501) 481-8930
- Fax
- (501) 408-4699
- NPI assigned
- May 15, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | Primary |
Addresses
Primary practice location
1306 Military Rd Ste 1
Benton, AR 72015-2732
Mailing address
2915 Saint Andrews Dr
Benton, AR 72019-6874
Phone (501) 481-8930
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arkansas Therapy Outreach, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Developmental Disabilities Clinic/Center
- Benton, AR
- NPI 1568986248
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494806400000",
"number": "1255868774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2915 SAINT ANDREWS DR",
"city": "BENTON",
"state": "AR",
"postal_code": "720196874",
"telephone_number": "501-481-8930",
"fax_number": "501-408-4699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1306 MILITARY RD STE 1",
"city": "BENTON",
"state": "AR",
"postal_code": "720152732",
"telephone_number": "501-481-8930",
"fax_number": "501-408-4699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNWELL",
"first_name": "STACIE",
"middle_name": "MICHELLE",
"credential": "MSED",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-15",
"last_updated": "2017-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Benton, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.