Provider Demographics
NPI:1902353006
Name:LUNSFORD, MARY ANNE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANNE
Last Name:LUNSFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5540
Mailing Address - Country:US
Mailing Address - Phone:479-226-8340
Mailing Address - Fax:479-259-9871
Practice Address - Street 1:7600 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5540
Practice Address - Country:US
Practice Address - Phone:479-226-8340
Practice Address - Fax:479-259-9871
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR066983163W00000X
ARA005198363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
0179196OtherAANP
ARR066983OtherAR NURSING LICESNCE
OKR0119211OtherOK. RN LICENSE