Provider Demographics
NPI:1053880427
Name:MCDOWELL, LASONDRA
Entity type:Individual
Prefix:
First Name:LASONDRA
Middle Name:
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3969 EASTERN SLOPE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-1773
Mailing Address - Country:US
Mailing Address - Phone:501-541-5924
Mailing Address - Fax:
Practice Address - Street 1:6520 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4732
Practice Address - Country:US
Practice Address - Phone:501-541-5924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR55553747A0650X, 385H00000X
AR186261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR233471755Medicaid