Basic Information
| Provider Information | |||||||||
| NPI: | 1922361740 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRISON | ||||||||
| FirstName: | LYNNETTE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10068 WAGER RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727629049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016731393 | ||||||||
| FaxNumber: | 4797633066 | ||||||||
| Practice Location | |||||||||
| Address1: | 1160 S 40TH ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727624832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797561702 | ||||||||
| FaxNumber: | 4797561742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 26063 | WV | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QH0002X | E-9342 | AR | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207Q00000X | E-9342 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 216681001 | 05 | AR | MEDICAID |