Provider Demographics
NPI:1851470140
Name:WALLEY, LINDSEY N (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:N
Last Name:WALLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:FORDYCE
Mailing Address - State:AR
Mailing Address - Zip Code:71742-3025
Mailing Address - Country:US
Mailing Address - Phone:870-352-3525
Mailing Address - Fax:870-352-3533
Practice Address - Street 1:110 N CLIFTON ST
Practice Address - Street 2:
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742-3025
Practice Address - Country:US
Practice Address - Phone:870-352-3525
Practice Address - Fax:870-352-3533
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168585001Medicaid