Provider Demographics
NPI:1275173544
Name:HEADLEY, LANA (APN)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:HEADLEY
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 144
Mailing Address - Street 2:
Mailing Address - City:VANNDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72387-0144
Mailing Address - Country:US
Mailing Address - Phone:870-362-9028
Mailing Address - Fax:
Practice Address - Street 1:209 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:AR
Practice Address - Zip Code:72432-1243
Practice Address - Country:US
Practice Address - Phone:870-578-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR122100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine