Provider Demographics
NPI:1215222336
Name:FARRIS, CONSTANCE LEEANN (APRN)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:LEEANN
Last Name:FARRIS
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 1:2305 CHAMPAGNOLLE RD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4816
Mailing Address - Country:US
Mailing Address - Phone:870-864-8010
Mailing Address - Fax:870-875-1897
Practice Address - Street 1:2305 CHAMPAGNOLLE RD
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4816
Practice Address - Country:US
Practice Address - Phone:870-864-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR220687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily