Healthcare Provider Details

I. General information

NPI: 1902353006
Provider Name (Legal Business Name): MARY ANNE LUNSFORD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 ROGERS AVE
FORT SMITH AR
72903-5540
US

IV. Provider business mailing address

7600 ROGERS AVE
FORT SMITH AR
72903-5540
US

V. Phone/Fax

Practice location:
  • Phone: 479-226-8340
  • Fax: 479-259-9871
Mailing address:
  • Phone: 479-226-8340
  • Fax: 479-259-9871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR066983
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005198
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: