Healthcare Provider Details

I. General information

NPI: 1851937254
Provider Name (Legal Business Name): LONNELL O SEAMSTER SR. NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WOODY DRIVE
ALEXANDER AR
72022
US

IV. Provider business mailing address

2715 S LINDEN ST
PINE BLUFF AR
71603-5371
US

V. Phone/Fax

Practice location:
  • Phone: 501-682-9800
  • Fax:
Mailing address:
  • Phone: 870-330-1358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number122470
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: