Provider Demographics
NPI:1619563343
Name:BEAUFFORD, LAURA ANN (APRN-CNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:BEAUFFORD
Suffix:
Gender:F
Credentials:APRN-CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 W TRUCKERS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5637
Mailing Address - Country:US
Mailing Address - Phone:479-973-6000
Mailing Address - Fax:479-571-5390
Practice Address - Street 1:1955 W TRUCKERS DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5637
Practice Address - Country:US
Practice Address - Phone:479-973-6000
Practice Address - Fax:479-571-5390
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1022166363LP0808X
AR216764363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR272993758Medicaid
TX1022166Medicaid