Healthcare Provider Details

I. General information

NPI: 1821419094
Provider Name (Legal Business Name): LANE RICHARD SALAZAR DNP, APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N GREENWOOD AVE
FORT SMITH AR
72901-3454
US

IV. Provider business mailing address

302 N GREENWOOD AVE
FORT SMITH AR
72901-3454
US

V. Phone/Fax

Practice location:
  • Phone: 479-414-4467
  • Fax:
Mailing address:
  • Phone: 479-414-4467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR74308
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA004003
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: