Provider Demographics
NPI:1679050397
Name:FARMER, GAYE LYNNE (LPN)
Entity Type:Individual
Prefix:MS
First Name:GAYE
Middle Name:LYNNE
Last Name:FARMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-2252
Mailing Address - Country:US
Mailing Address - Phone:479-754-6210
Mailing Address - Fax:800-354-2182
Practice Address - Street 1:1000 W BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-2252
Practice Address - Country:US
Practice Address - Phone:479-754-6210
Practice Address - Fax:800-354-2182
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL42926164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103106724Medicaid