Provider Demographics
NPI:1104122803
Name:PONWITH, LINDSEY JANE (APRN)
Entity type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:JANE
Last Name:PONWITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:LINDSEY
Other - Middle Name:JANE
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:8114 CANTRELL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2421
Mailing Address - Country:US
Mailing Address - Phone:501-779-8554
Mailing Address - Fax:501-222-8034
Practice Address - Street 1:8114 CANTRELL RD STE 201
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2421
Practice Address - Country:US
Practice Address - Phone:501-779-8554
Practice Address - Fax:501-222-8034
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003477363LF0000X
ARA03477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR188129758Medicaid
AR188129758Medicaid