Provider Demographics
NPI:1578375952
Name:LAKE TOWN WELLNESS LIMITED
Entity type:Organization
Organization Name:LAKE TOWN WELLNESS LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-BC
Authorized Official - Phone:501-250-6688
Mailing Address - Street 1:1031 HIGHWAY 25B
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-2034
Mailing Address - Country:US
Mailing Address - Phone:501-436-2620
Mailing Address - Fax:504-436-2620
Practice Address - Street 1:1031 HIGHWAY 25B
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-2034
Practice Address - Country:US
Practice Address - Phone:501-436-2620
Practice Address - Fax:504-436-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty