Healthcare Provider Details

I. General information

NPI: 1952817587
Provider Name (Legal Business Name): LAUREN PAIGE WAHLMEIER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN PAIGE CARR PA-C

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 WE KNIGHT DR
FORT SMITH AR
72903-6254
US

IV. Provider business mailing address

508 N 14TH ST
VAN BUREN AR
72956-4548
US

V. Phone/Fax

Practice location:
  • Phone: 479-709-6700
  • Fax:
Mailing address:
  • Phone: 479-651-8749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPT2018-004
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: