Provider Demographics
NPI:1710259049
Name:FAULKNER, LAUREN BROOKE (APN)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BROOKE
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 MEDICAL CENTER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-6873
Mailing Address - Country:US
Mailing Address - Phone:501-745-7888
Mailing Address - Fax:501-745-4401
Practice Address - Street 1:465 MEDICAL CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-1529
Practice Address - Country:US
Practice Address - Phone:501-745-7888
Practice Address - Fax:501-745-4401
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03650363LF0000X
ARA003650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR133965749Medicaid