Provider Demographics
NPI:1295292332
Name:WHITAKER, LYNDSEY (APRN)
Entity type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4375 N VANTAGE DR STE 305
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4984
Mailing Address - Country:US
Mailing Address - Phone:479-443-5100
Mailing Address - Fax:479-443-5117
Practice Address - Street 1:4375 N VANTAGE DR STE 305
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4984
Practice Address - Country:US
Practice Address - Phone:479-443-5100
Practice Address - Fax:479-443-5117
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA006079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily