Northwest Arkansas Crisis Stabilization Unit | |
105 N Mill Ave Fayetteville AR 72701-4273 | |
(479) 332-0800 | |
(479) 332-0801 |
Full Name | Northwest Arkansas Crisis Stabilization Unit |
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Speciality | Psychiatric Unit |
Location | 105 N Mill Ave, Fayetteville, Arkansas |
Authorized Official Name and Position | Amanda D George (VICE CHANCELLOR-CHIEF FINANCIAL OFF) |
Authorized Official Contact | 5016865670 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Northwest Arkansas Crisis Stabilization Unit 105 N Mill Ave Fayetteville AR 72701-4273 Ph: (501) 686-8000 | Northwest Arkansas Crisis Stabilization Unit 105 N Mill Ave Fayetteville AR 72701-4273 Ph: (479) 332-0800 |
NPI Number | 1134879208 |
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Provider Enumeration Date | 03/24/2022 |
Last Update Date | 08/03/2022 |
Certification Date | 08/03/2022 |
Medicare PECOS PAC ID | 4082528955 |
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Medicare Enrollment ID | O20220621002780 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134879208 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
Provider Name | Jon Rubenow |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1013970797 PECOS PAC ID: 6507944030 Enrollment ID: I20100903000319 |
Provider Name | Jennifer Penne |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497968101 PECOS PAC ID: 9133383557 Enrollment ID: I20120615000304 |
Provider Name | Kristen E Mcallister |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1346664968 PECOS PAC ID: 2264785294 Enrollment ID: I20181022001544 |
Provider Name | Stephanie Bohannon |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104459114 PECOS PAC ID: 5496168031 Enrollment ID: I20201229000043 |
Provider Name | Mary Anna Tripp |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1811416217 PECOS PAC ID: 2365844230 Enrollment ID: I20210714003256 |
Provider Name | Paulette Lynn Sheagren |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1861684060 PECOS PAC ID: 1456741826 Enrollment ID: I20211130001053 |
Provider Name | Heather A Humphrey |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1366198798 PECOS PAC ID: 1557738614 Enrollment ID: I20221102000280 |
Provider Name | Robert Erik Mayo |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1568809440 PECOS PAC ID: 4587004387 Enrollment ID: I20240426001838 |
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