Healthcare Provider Details

I. General information

NPI: 1134907637
Provider Name (Legal Business Name): ELIZABETH VICTORIA MAECHLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH VICTORIA SPENCER RN

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 DALLAS ST
FORT SMITH AR
72903-5690
US

IV. Provider business mailing address

7900 DALLAS ST
FORT SMITH AR
72903-5690
US

V. Phone/Fax

Practice location:
  • Phone: 479-242-6647
  • Fax: 479-250-0505
Mailing address:
  • Phone: 479-242-6647
  • Fax: 479-250-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200663
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number223995
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: