Healthcare Provider Details

I. General information

NPI: 1205824539
Provider Name (Legal Business Name): LANA ANN ELKINS M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3444 OLD GREENWOOD RD SUITE C
FORT SMITH AR
72903-5462
US

IV. Provider business mailing address

2200 DUNDEE DR
FORT SMITH AR
72908-0933
US

V. Phone/Fax

Practice location:
  • Phone: 479-452-6937
  • Fax: 479-646-3828
Mailing address:
  • Phone: 479-452-6937
  • Fax: 479-646-3828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP9009017
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: