Healthcare Provider Details

I. General information

NPI: 1407982267
Provider Name (Legal Business Name): LAURA JEAN MEACHUM MENCER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH ST
LITTLE ROCK AR
72205-5446
US

IV. Provider business mailing address

12722 VALLEYWOOD DR
LITTLE ROCK AR
72211-3376
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-6799
  • Fax: 501-257-6800
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberS01057
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: