Provider Demographics
NPI:1003043936
Name:PAULK, LAUREN CANTWELL (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CANTWELL
Last Name:PAULK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 HAMPSTEAD HEATH
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718-5501
Mailing Address - Country:US
Mailing Address - Phone:804-874-3427
Mailing Address - Fax:479-316-6899
Practice Address - Street 1:1706 E JOYCE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5249
Practice Address - Country:US
Practice Address - Phone:479-966-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-11093207R00000X
VA0116021809390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program