Healthcare Provider Details

I. General information

NPI: 1134044795
Provider Name (Legal Business Name): KRISTEN LUCY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LINCOLN ST
LONOKE AR
72086-3618
US

IV. Provider business mailing address

800 LINCOLN ST
LONOKE AR
72086-3618
US

V. Phone/Fax

Practice location:
  • Phone: 501-676-3839
  • Fax: 501-676-0195
Mailing address:
  • Phone: 501-616-3839
  • Fax: 501-676-0195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number230074
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: