Provider Demographics
NPI:1437410545
Name:MCDANIEL, SUSAN LYNN (ANP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9755 W. STATE HWY 22
Mailing Address - Street 2:P.O BOX 130
Mailing Address - City:RATCLIFF
Mailing Address - State:AR
Mailing Address - Zip Code:72951
Mailing Address - Country:US
Mailing Address - Phone:479-431-2050
Mailing Address - Fax:479-431-2051
Practice Address - Street 1:4900 KELLEY HWY
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72904
Practice Address - Country:US
Practice Address - Phone:479-785-5700
Practice Address - Fax:479-785-5708
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily