Individual
SOUTNAKHON PHANDANOUVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
4300 GRAND AVE, FORT SMITH, AR 72904-7028
(479) 208-4601
Mailing address
5728 KIBLER RD, VAN BUREN, AR 72956-7576
(479) 459-0046
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
214525
AR
Other
Enumeration date
01/11/2021
Last updated
06/05/2025
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