Healthcare Provider Details

I. General information

NPI: 1215082458
Provider Name (Legal Business Name): KATHY KENNEDY LAWLESS RN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZIE LAWLESS RN, APN

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 COUNTY ROAD 496
MOUNTAIN HOME AR
72653-5274
US

IV. Provider business mailing address

255 COUNTY ROAD 496
MOUNTAIN HOME AR
72653-5274
US

V. Phone/Fax

Practice location:
  • Phone: 225-719-2540
  • Fax:
Mailing address:
  • Phone: 225-719-2540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003831
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR086276
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN087116
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: