Healthcare Provider Details

I. General information

NPI: 1134596927
Provider Name (Legal Business Name): LANSDELL FAMILY CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 07/14/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E COLLIN RAYE DR
DE QUEEN AR
71832-8048
US

IV. Provider business mailing address

PO BOX 295
LOCKESBURG AR
71846-0295
US

V. Phone/Fax

Practice location:
  • Phone: 870-584-1053
  • Fax: 870-584-2087
Mailing address:
  • Phone: 870-289-5865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003557
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAWNYA L LANSDELL
Title or Position: PRESIDENT
Credential: CNP
Phone: 870-584-1053