1922537695 NPI number — DR. REBECCA MEREDITH STORMENT PHD

Table of content: DR. REBECCA MEREDITH STORMENT PHD (NPI 1922537695)

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:
04/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 N COLLEGE AVE STE 306
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:
72701-4381
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:
300 N COLLEGE AVE STE 306
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:
72701-4381
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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