Healthcare Provider Details

I. General information

NPI: 1649970997
Provider Name (Legal Business Name): ANDREA LUKER APRN, FNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 STATE HIGHWAY 22 W
DARDANELLE AR
72834-2909
US

IV. Provider business mailing address

1652 STATE HIGHWAY 22 W
DARDANELLE AR
72834-2909
US

V. Phone/Fax

Practice location:
  • Phone: 479-229-8000
  • Fax:
Mailing address:
  • Phone: 479-229-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221846
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: