Provider Demographics
NPI:1730686601
Name:LAWRENCE, DANA KAYLEIGH (APRN)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:KAYLEIGH
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 MILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3329
Mailing Address - Country:US
Mailing Address - Phone:501-317-0915
Mailing Address - Fax:
Practice Address - Street 1:600 AUTUMN RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3606
Practice Address - Country:US
Practice Address - Phone:501-526-1046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily