Provider Demographics
NPI:1285865865
Name:LISA A BEARDEN MD PA
Entity Type:Organization
Organization Name:LISA A BEARDEN MD PA
Other - Org Name:LISA A DUCKWORTH MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-534-3608
Mailing Address - Street 1:1609 W 40TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6319
Mailing Address - Country:US
Mailing Address - Phone:870-534-3608
Mailing Address - Fax:
Practice Address - Street 1:1609 W 40TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6319
Practice Address - Country:US
Practice Address - Phone:870-534-3608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6081261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty