Basic Information
| Provider Information | |||||||||
| NPI: | 1164410544 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STIEFVATER | ||||||||
| FirstName: | TROY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22390 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719032390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002351415 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11401 INTERSTATE 30 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722097042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5014557100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 03/28/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | C01310 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | P00266924 | 01 | RR MEDICARE GROUP CK6327 | OTHER | 5W501 | 01 | AR | BCBS | OTHER |