| Doctor Name: | MR. JOHNNY MAC STEVENS |
| NPI Number: | 1093104895 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APRN |
| License Number: | A004282 |
| Business Practice Address: | 16485 Aubrey Long Rd Gentry, AR - 727349671 |
| Business Phone Number: | 4795305279 |
| Business Fax Number: | |
| Mailing Address: | 3721 East Hwy 412, Suite B SILOAM SPRINGS |
| State: | AR |
| Postal Code: | 73761 |
| Phone Number: | 4792153080 |
| Fax Number: | 4795494059 |
| NPI Enumeration Date: | 01/16/2015 |
| NPI Last Update Date: | 05/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | A004282 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |