Provider Demographics
NPI:1437526241
Name:EDWARDS, LISA (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:EDWARDS
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 1:2526 HIGHWAY 65 S
Mailing Address - Street 2:STE 201
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-6657
Mailing Address - Country:US
Mailing Address - Phone:501-745-3388
Mailing Address - Fax:501-745-3006
Practice Address - Street 1:2526 HIGHWAY 65 S
Practice Address - Street 2:STE 201
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6657
Practice Address - Country:US
Practice Address - Phone:501-745-3388
Practice Address - Fax:501-745-3006
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA004514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily