Healthcare Provider Details

I. General information

NPI: 1144243866
Provider Name (Legal Business Name): LYNDA GAIL RUSSELL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 KELLER ST
ASHDOWN AR
71822-2810
US

IV. Provider business mailing address

663 LITTLE RIVER 10
FOREMAN AR
71836-9082
US

V. Phone/Fax

Practice location:
  • Phone: 870-898-3831
  • Fax: 870-898-5357
Mailing address:
  • Phone: 870-542-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberA01057
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: