Provider Demographics
NPI:1861744773
Name:WEATHERFORD, LAURA MARIE (APN, FNP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:WEATHERFORD
Suffix:
Gender:F
Credentials:APN, FNP-BC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:CARLISLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9178
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-9178
Mailing Address - Country:US
Mailing Address - Phone:800-824-4094
Mailing Address - Fax:479-968-1673
Practice Address - Street 1:411 W WASHINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-2781
Practice Address - Country:US
Practice Address - Phone:870-275-4272
Practice Address - Fax:870-275-4277
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003761363LF0000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily