Provider Demographics
NPI:1063965192
Name:FUNMAKER, ADRIANNE R (APRN)
Entity type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:R
Last Name:FUNMAKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ADRIANNE
Other - Middle Name:R
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:11501 HURON LN STE 5
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2491
Mailing Address - Country:US
Mailing Address - Phone:501-904-4762
Mailing Address - Fax:501-708-2185
Practice Address - Street 1:11501 HURON LN STE 5
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2491
Practice Address - Country:US
Practice Address - Phone:501-904-4762
Practice Address - Fax:501-708-2185
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004844363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics