Healthcare Provider Details

I. General information

NPI: 1033272653
Provider Name (Legal Business Name): LAURA ELIZABETH KIRKSEY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N. SCHOOL ST.
BEARDEN AR
71720-0198
US

IV. Provider business mailing address

PO BOX 198
BEARDEN AR
71720-0198
US

V. Phone/Fax

Practice location:
  • Phone: 870-687-3637
  • Fax: 870-687-2502
Mailing address:
  • Phone: 870-687-3637
  • Fax: 870-687-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberP01726
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01470 ANP
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR38054
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: