Provider Demographics
NPI:1447407671
Name:HARRELL, LANCE MICHAEL (APN - BC)
Entity type:Individual
Prefix:MR
First Name:LANCE
Middle Name:MICHAEL
Last Name:HARRELL
Suffix:
Gender:M
Credentials:APN - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 HORIZON DR.
Mailing Address - Street 2:STE. 4
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-0000
Mailing Address - Country:US
Mailing Address - Phone:870-732-0332
Mailing Address - Fax:870-732-3078
Practice Address - Street 1:2201 HORIZON DR.
Practice Address - Street 2:STE. 4
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-0000
Practice Address - Country:US
Practice Address - Phone:870-732-0332
Practice Address - Fax:870-732-3078
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily