Provider Demographics
NPI:1881285336
Name:GAVIN, LINZY (APRN)
Entity type:Individual
Prefix:
First Name:LINZY
Middle Name:
Last Name:GAVIN
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4196 HIGHWAY 62 412 STE A
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-8002
Mailing Address - Country:US
Mailing Address - Phone:870-325-6202
Mailing Address - Fax:870-325-6316
Practice Address - Street 1:701 MAIN ST
Practice Address - Street 2:
Practice Address - City:RISON
Practice Address - State:AR
Practice Address - Zip Code:71665-9563
Practice Address - Country:US
Practice Address - Phone:870-325-6202
Practice Address - Fax:870-325-6316
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR214598363LA2200X, 363LG0600X
LA223879363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty