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General NPI Number Information
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NPI Number | 1578375952
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Entity Type | Organization
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Legal Business Name | LAKE TOWN WELLNESS LIMITED
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 1031 HIGHWAY 25B
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City | HEBER SPRINGS
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State | AR
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Zip | 72543-2034
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Country | US
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Telephone | 501-436-2620
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Fax | 504-436-2620
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Provider Business Mailing Address
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Address Line | 1031 HIGHWAY 25B
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City | HEBER SPRINGS
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State | AR
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Zip | 72543-2034
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Country | US
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Telephone | 501-436-2620
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Fax | 504-436-2620
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE MARIE THOMPSON
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Credential | DNP, APRN, FNP-BC
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Telephone | 501-250-6688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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