Healthcare Provider Details

I. General information

NPI: 1710259049
Provider Name (Legal Business Name): LAUREN BROOKE FAULKNER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SKYLINE DR
CONWAY AR
72032-2857
US

IV. Provider business mailing address

1125 SKYLINE DR
CONWAY AR
72032-2857
US

V. Phone/Fax

Practice location:
  • Phone: 501-504-7171
  • Fax: 877-370-4292
Mailing address:
  • Phone: 501-504-7171
  • Fax: 877-370-4292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003650
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA03650
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: