Provider Demographics
NPI:1346414745
Name:NELSON, LARA LYN (APRN)
Entity Type:Individual
Prefix:MS
First Name:LARA
Middle Name:LYN
Last Name:NELSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:LARA
Other - Middle Name:LYN
Other - Last Name:NELSON-JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:4196 HIGHWAY 62 412 STE A
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-8002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 GLADES RD
Practice Address - Street 2:
Practice Address - City:GATLINBURG
Practice Address - State:TN
Practice Address - Zip Code:37738-5658
Practice Address - Country:US
Practice Address - Phone:865-436-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004624207Q00000X
SC25042363LF0000X
TN33103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine