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General NPI Number Information
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NPI Number | 1114534252
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Entity Type | Organization
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Legal Business Name | LANSDELL FAMILY CLINIC PLLC
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 4102 GIBSON LN
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City | TEXARKANA
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State | TX
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Zip | 75503-1120
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Country | US
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Telephone | 903-255-7923
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Fax | 866-282-5926
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Provider Business Mailing Address
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Address Line | 500 E COLLIN RAYE DR STE 2
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City | DE QUEEN
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State | AR
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Zip | 71832-8068
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Country | US
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Telephone | 870-584-1053
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MICHAEL WAYNE LANSDELL
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Credential |
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Telephone | 870-584-1053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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