Provider Demographics
NPI:1790484582
Name:FAULKNER, JON LAWRENCE (HIS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:LAWRENCE
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3484 W WEDINGTON DR STE 2
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-7164
Mailing Address - Country:US
Mailing Address - Phone:479-396-4800
Mailing Address - Fax:
Practice Address - Street 1:3484 W WEDINGTON DR STE 2
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-7164
Practice Address - Country:US
Practice Address - Phone:479-396-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR623237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist