1922537695 NPI number — DR. REBECCA MEREDITH STORMENT PHD

Table of content: DR. WILLIAM J PETTA DDS (NPI 1215039334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922537695 NPI number — DR. REBECCA MEREDITH STORMENT PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STORMENT
Provider First Name:
REBECCA
Provider Middle Name:
MEREDITH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STORMENT
Provider Other First Name:
REBECCA
Provider Other Middle Name:
MEREDITH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1922537695
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 W CENTER ST STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72701-6081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-348-4221
Provider Business Mailing Address Fax Number:
479-334-3223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W CENTER ST STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72701-6081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-348-4221
Provider Business Practice Location Address Fax Number:
479-334-3223
Provider Enumeration Date:
06/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  202134 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 202134 . This is a "STATE PSYCHOLOGY LICENSE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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