MEDICARE: LAKE TOWN WELLNESS LIMITED

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

General Provider Information

NPI Number	:	1578375952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE TOWN WELLNESS LIMITED

Provider Business Mailing Address
First Line	:	509 N 2ND ST
Second Line	:
City	:	HEBER SPRINGS
State	:	AR
Zip	:	72543-2513
Country	:	US
Telephone Number	:	501-436-2620
Fax Number	:	504-436-2620

Provider Business Practice Location Address
First Line	:	509 N 2ND ST
Second Line	:
City	:	HEBER SPRINGS
State	:	AR
Zip	:	72543-2513
Country	:	US
Telephone Number	:	501-436-2620
Fax Number	:	504-436-2620

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHANIE MARIE THOMPSON
Credential	:	DNP, APRN, FNP-BC
Telephone Number	:	501-250-6688

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	03/27/2026

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