Provider Demographics
NPI:1073142683
Name:LINEBERRY, LYNN MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:LINEBERRY
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 1:6801 ROGERS AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4067
Mailing Address - Country:US
Mailing Address - Phone:479-573-3042
Mailing Address - Fax:479-452-2924
Practice Address - Street 1:6801 ROGERS AVE FL 3
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4067
Practice Address - Country:US
Practice Address - Phone:479-573-3042
Practice Address - Fax:479-452-2924
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily