Healthcare Provider Details

I. General information

NPI: 1104842483
Provider Name (Legal Business Name): LESLIE GRACE LANDRUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 PARKWAY CIR STE 100
SPRINGDALE AR
72762-5328
US

IV. Provider business mailing address

3901 PARKWAY CIR STE 100
SPRINGDALE AR
72762-5328
US

V. Phone/Fax

Practice location:
  • Phone: 479-587-1700
  • Fax: 479-587-1366
Mailing address:
  • Phone: 479-587-1700
  • Fax: 479-587-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberC7717
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC7717
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: