Provider Demographics
NPI:1033969290
Name:MAUMELLE FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:MAUMELLE FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:STALLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:501-734-8085
Mailing Address - Street 1:2001 CLUB MANOR DR STE S
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7417
Mailing Address - Country:US
Mailing Address - Phone:501-734-8085
Mailing Address - Fax:501-734-8088
Practice Address - Street 1:2001 CLUB MANOR DR STE S
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-7417
Practice Address - Country:US
Practice Address - Phone:501-734-8085
Practice Address - Fax:501-734-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty