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General NPI Number Information
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NPI Number | 1003043936
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Entity Type | Individual
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Provider Name | LAUREN CANTWELL PAULK MD
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Gender | Female
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 1706 E JOYCE BLVD STE 2
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5249
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Country | US
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Telephone | 479-966-9370
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Fax |
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Provider Business Mailing Address
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Address Line | 802 HAMPSTEAD HEATH
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City | CAVE SPRINGS
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State | AR
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Zip | 72718-5501
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Country | US
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Telephone | 804-874-3427
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Fax | 479-316-6899
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E-11093
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License Number State | AR
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