Provider Demographics
NPI:1356034748
Name:SCANTLING, JUSTIN LEE (APRN)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LEE
Last Name:SCANTLING
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-3443
Mailing Address - Country:US
Mailing Address - Phone:479-675-2800
Mailing Address - Fax:479-675-1373
Practice Address - Street 1:880 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927-3443
Practice Address - Country:US
Practice Address - Phone:479-675-2800
Practice Address - Fax:479-675-1373
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR224587207R00000X, 207RG0300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine