Healthcare Provider Details

I. General information

NPI: 1861634826
Provider Name (Legal Business Name): ALISA R. LANCASTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 BATESVILLE BLVD
BATESVILLE AR
72501-7782
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 870-569-4934
  • Fax: 870-569-4948
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-347-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003205
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: