Healthcare Provider Details

I. General information

NPI: 1619563343
Provider Name (Legal Business Name): LAURA ANN BEAUFFORD APRN-CNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 08/21/2022
Certification Date: 08/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 W TRUCKERS DR
FAYETTEVILLE AR
72704-5637
US

IV. Provider business mailing address

1955 W TRUCKERS DR
FAYETTEVILLE AR
72704-5637
US

V. Phone/Fax

Practice location:
  • Phone: 479-973-6000
  • Fax: 479-571-5390
Mailing address:
  • Phone: 479-973-6000
  • Fax: 479-571-5390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1022166
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number216764
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: