Provider Demographics
NPI:1548317340
Name:BRAUTNICK, LYNSAY LEIGHANNE (MD)
Entity type:Individual
Prefix:MRS
First Name:LYNSAY
Middle Name:LEIGHANNE
Last Name:BRAUTNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNSAY
Other - Middle Name:LEIGHANNE
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3232 N NORTH HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4005
Mailing Address - Country:US
Mailing Address - Phone:479-587-1700
Mailing Address - Fax:479-587-1366
Practice Address - Street 1:3232 N NORTH HILLS BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4005
Practice Address - Country:US
Practice Address - Phone:479-587-1700
Practice Address - Fax:479-587-1366
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6989207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
200347920AOtherOK MCD
OK200347920 AMedicaid
MO1548317340Medicaid
AR188522001Medicaid
AR188522001Medicaid