Provider Demographics
NPI:1033272653
Name:KIRKSEY, LAURA ELIZABETH (APN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:KIRKSEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:BEARDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71720-0198
Mailing Address - Country:US
Mailing Address - Phone:870-687-3637
Mailing Address - Fax:870-687-2502
Practice Address - Street 1:150 N. SCHOOL ST.
Practice Address - Street 2:
Practice Address - City:BEARDEN
Practice Address - State:AR
Practice Address - Zip Code:71720-0198
Practice Address - Country:US
Practice Address - Phone:870-687-3637
Practice Address - Fax:870-687-2502
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR38054163W00000X
ARP01726363L00000X
ARA01470 ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR140635758Medicaid
P17723Medicare UPIN
AR140635758Medicaid