Healthcare Provider Details

I. General information

NPI: 1740756659
Provider Name (Legal Business Name): LESIA PRATT AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LESIA PRATT AGPCNP

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 S ROCK ST
SHERIDAN AR
72150-7066
US

IV. Provider business mailing address

3180 MAE DR
WHITE HALL AR
71602-8804
US

V. Phone/Fax

Practice location:
  • Phone: 870-917-2289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA005645
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA005645
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: