Healthcare Provider Details

I. General information

NPI: 1316444672
Provider Name (Legal Business Name): JENNIFER LAWLESS BURCHFIELD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANN LAWLESS

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TOWSON AVE
FORT SMITH AR
72901-4921
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 479-441-4000
  • Fax: 479-441-4935
Mailing address:
  • Phone: 479-441-4000
  • Fax: 479-441-4935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2018026930
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number217304
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: