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NPI Code Detail

MEDICARE: LLE MEDICAL MANAGEMENT

MEDICARE: LLE MEDICAL MANAGEMENT
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
1363LF0000XFamily Nurse PractitionerAO1691AR

General Provider Information

NPI Number : 1124153259
Entity Type Code : Organization
Provider Name (Legal Business Name) : LLE MEDICAL MANAGEMENT
Provider Business Mailing Address
First Line : 606 W ARCH AVE
Second Line : STE A
City : SEARCY
State : AR
Zip : 72143-5206
Country : US
Telephone Number : 501-279-0211
Fax Number : 501-279-0213
Provider Business Practice Location Address
First Line : 606 W ARCH AVE
Second Line : STE A
City : SEARCY
State : AR
Zip : 72143-5206
Country : US
Telephone Number : 501-279-0211
Fax Number : 501-279-0213
Authorized Official
Title or Position : OWNER
Name : LORI L ELLIS
Credential : APN
Telephone Number : 501-279-0211
Provider Enumeration Date : 02/22/2007
Last Update Date : 08/22/2020

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Directions to “LLE MEDICAL MANAGEMENT ” Practice Location

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