Provider Demographics
NPI:1851328769
Name:BANWART, LYNDA D (NP-C)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:D
Last Name:BANWART
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 MEDICAL CENTER PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3214
Mailing Address - Country:US
Mailing Address - Phone:479-553-3360
Mailing Address - Fax:479-553-1911
Practice Address - Street 1:2900 MEDICAL CENTER PKWY STE 310
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3214
Practice Address - Country:US
Practice Address - Phone:479-553-3360
Practice Address - Fax:479-553-1911
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR234698363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425993409Medicaid
KSKA1177028Medicare PIN