Provider Demographics
NPI:1558560102
Name:BEARDEN, LISA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:500 SE PLAZA AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3104
Mailing Address - Country:US
Mailing Address - Phone:479-876-8111
Mailing Address - Fax:479-876-8110
Practice Address - Street 1:2900 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 370
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3204
Practice Address - Country:US
Practice Address - Phone:479-876-8111
Practice Address - Fax:479-876-8110
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6081207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178390001Medicaid