MEDICARE: MRS. LINDSEY JANE PONWITH APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	A03477	AR
2	363LF0000X	Family Nurse Practitioner	A003477	AR
3	363LF0000X	Family Nurse Practitioner	282083	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104122803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDSEY JANE PONWITH APRN

Provider Business Mailing Address
First Line	:	8114 CANTRELL RD STE 201
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-2421
Country	:	US
Telephone Number	:	501-779-8554
Fax Number	:	501-222-8034

Provider Business Practice Location Address
First Line	:	8114 CANTRELL RD STE 201
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-2421
Country	:	US
Telephone Number	:	501-779-8554
Fax Number	:	501-222-8034

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2011
Last Update Date	:	12/13/2025

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