Healthcare Provider Details

I. General information

NPI: 1609620657
Provider Name (Legal Business Name): LINDSAY JEANNE LAWRENCE ECDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. LINDSAY JEANNE CULP

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 AVONDALE CIR
WEST MEMPHIS AR
72301-1794
US

IV. Provider business mailing address

1600 AVONDALE CIR
WEST MEMPHIS AR
72301-1794
US

V. Phone/Fax

Practice location:
  • Phone: 870-733-9950
  • Fax: 870-733-9966
Mailing address:
  • Phone: 870-733-9950
  • Fax: 870-733-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number9274387
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number9274387
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: