Basic Information
| Provider Information | |||||||||
| NPI: | 1215902788 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENDALL | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | MICHELE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CREEL | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | MICHELE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | CRNA | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 601 W MAPLE AVE STE 503 | ||||||||
| Address2: | NORTHWEST ANESTHESIOLOGY ASSOCIATES | ||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727645376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797513722 | ||||||||
| FaxNumber: | 4797511099 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 W MAPLE AVE STE 503 | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727645376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797513722 | ||||||||
| FaxNumber: | 4797511099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | APN11874 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | C002663 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 168887001 | 05 | AR | MEDICAID |