Provider Demographics
NPI:1710381082
Name:FAULKNER, BRANDON C (APRN)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:C
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-3454
Mailing Address - Country:US
Mailing Address - Phone:501-776-7130
Mailing Address - Fax:501-776-6695
Practice Address - Street 1:302 N GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-3454
Practice Address - Country:US
Practice Address - Phone:501-776-7130
Practice Address - Fax:501-776-6695
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004225363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care