Healthcare Provider Details

I. General information

NPI: 1053880427
Provider Name (Legal Business Name): LASONDRA MCDOWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 BASELINE RD
LITTLE ROCK AR
72209-4732
US

IV. Provider business mailing address

3969 EASTERN SLOPE DR
ALEXANDER AR
72002-1773
US

V. Phone/Fax

Practice location:
  • Phone: 501-541-5924
  • Fax:
Mailing address:
  • Phone: 501-541-5924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberAR5555
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberAR5555
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number186
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: