Healthcare Provider Details

I. General information

NPI: 1922361740
Provider Name (Legal Business Name): LYNNETTE ANNE MORRISON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 S 40TH ST
SPRINGDALE AR
72762-4832
US

IV. Provider business mailing address

PO BOX 775641
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 479-756-1702
  • Fax: 479-756-1742
Mailing address:
  • Phone: 314-543-6979
  • Fax: 314-364-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26063
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberE-9342
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-9342
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: