Healthcare Provider Details

I. General information

NPI: 1275967390
Provider Name (Legal Business Name): LINDSEY WALLEY MD PLLC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N CLIFTON ST
FORDYCE AR
71742-3025
US

IV. Provider business mailing address

110 N CLIFTON ST
FORDYCE AR
71742-3025
US

V. Phone/Fax

Practice location:
  • Phone: 870-352-3525
  • Fax: 870-352-3533
Mailing address:
  • Phone: 870-352-3525
  • Fax: 870-352-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberE5091
License Number StateAR

VIII. Authorized Official

Name: DR. LINDSEY WALLEY
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 870-352-3525