Healthcare Provider Details

I. General information

NPI: 1164294963
Provider Name (Legal Business Name): SARAH RUSSELL DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 GREATHOUSE SPRINGS ROAD
JOHNSON AR
72741
US

IV. Provider business mailing address

1860 E BRENT LN
FAYETTEVILLE AR
72703-3153
US

V. Phone/Fax

Practice location:
  • Phone: 479-684-3000
  • Fax:
Mailing address:
  • Phone: 720-606-9875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number125923
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: