Provider Demographics
NPI:1629577697
Name:FALWELL, VANESSA (APRN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:FALWELL
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 1:1301 MCLAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-3633
Mailing Address - Country:US
Mailing Address - Phone:870-217-4071
Mailing Address - Fax:870-217-4072
Practice Address - Street 1:1301 MCLAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3633
Practice Address - Country:US
Practice Address - Phone:870-217-4071
Practice Address - Fax:870-217-4072
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily