Individual
LANE CLEMENTS AUSTELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1000 S 52ND ST, ROGERS, AR 72758-8610
(479) 271-9607
(479) 271-2133
Mailing address
1000 S 52ND ST, ROGERS, AR 72758-8610
(901) 517-1434
(479) 271-2133
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5312
TN
363A00000X
Physician Assistant
Primary
PA-1163
AR
Other
Enumeration date
12/05/2022
Last updated
10/31/2024
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