Healthcare Provider Details

I. General information

NPI: 1366258774
Provider Name (Legal Business Name): MISHANN LUEDDERS-EAST APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4196 HIGHWAY 62 412 STE A
HARDY AR
72542-8002
US

IV. Provider business mailing address

4196 HIGHWAY 62 412 STE A
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 870-895-2015
  • Fax:
Mailing address:
  • Phone: 870-895-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number120637
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: