Provider Demographics
NPI:1205392164
Name:CARLTON, LAURIE LYNN (APRN, AGNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:LYNN
Last Name:CARLTON
Suffix:
Gender:F
Credentials:APRN, AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 CRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LAVACA
Mailing Address - State:AR
Mailing Address - Zip Code:72941-5313
Mailing Address - Country:US
Mailing Address - Phone:479-926-4434
Mailing Address - Fax:
Practice Address - Street 1:4600 TOWSON AVE STE 101W1
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7830
Practice Address - Country:US
Practice Address - Phone:479-226-3132
Practice Address - Fax:479-226-3136
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA006102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner