Basic Information
| Provider Information | |||||||||
| NPI: | 1437410545 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDANIEL | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9755 W. STATE HWY 22 | ||||||||
| Address2: | P.O BOX 130 | ||||||||
| City: | RATCLIFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794312050 | ||||||||
| FaxNumber: | 4794312051 | ||||||||
| Practice Location | |||||||||
| Address1: | 4900 KELLEY HWY | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797855700 | ||||||||
| FaxNumber: | 4797855708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2012 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A03696 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.