SOUTNAKHON PHANDANOUVONG APRN
NPI 1780273250
Nurse Practitioner - Family in Fort Smith, AR

Active since January 11, 2021PECOS EnrolledAccepts Medicare Assignment
4300 GRAND AVE, FORT SMITH, AR 72904(479) 208-4601 Get Directions Write a Review

NPPES record last updated: June 5, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jun 5, 2025, Jan 11, 2021 (2 updates tracked since 2021).

About Soutnakhon Phandanouvong Aprn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTNAKHON PHANDANOUVONG APRN (NPI 1780273250) is an individual family provider in Fort Smith, Arkansas, licensed in Arkansas (214525) and active in the NPI registry since January 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1780273250
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameSOUTNAKHON PHANDANOUVONGCredential: APRN
Location Address4300 GRAND AVEFort Smith, AR 72904-7028
Mailing Address5728 Kibler RdVan Buren, AR 72956-7576 · (479) 459-0046
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateJanuary 11, 2021
Last NPPES UpdateJune 5, 20252 updates tracked since enumeration
NPPES CertifiedJune 5, 2025
NPI 1780273250 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License Licensed in AR · 214525
4300 GRAND AVE, Fort Smith, AR 72904

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Soutnakhon Phandanouvong Aprn is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2163837949
PECOS Enrollment IDI20210209002792, I20250605000483
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
120 services72 patients
Blood test, lipids (cholesterol and triglycerides) 80061
A lipid panel is a blood test that measures fats and fatty substances, such as cholesterol and triglycerides. These substances are used by your body as a source of energy. High levels can lead to health issues, including heart disease.
77 services50 patients
Hemoglobin a1c level 83036
Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.
69 services35 patients
Automated urinalysis test 81003
An automated urinalysis test is a routine examination that checks your urine for various substances. It can help identify potential health issues such as kidney problems or diabetes. The test uses a machine to analyze a small urine sample, providing quick and accurate results.
36 services21 patients
Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus and influenza 87428
This test uses a method called immunoassay to identify severe acute respiratory syndrome coronavirus and influenza. It works by detecting specific proteins (antigens) in a sample, like a nasal swab. It's a powerful tool in diagnosing these viral infections.
17 services14 patients
Urine microalbumin (protein) analysis 82044
Urine microalbumin analysis is a test that measures the amount of a protein called albumin in your urine. This protein is usually present in very small amounts, but higher levels can indicate kidney issues. The test is non-invasive and involves a simple urine sample.
11 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 72904 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$79.72 typical visit price
range $51.36 – $157.74
Typical copayment $19.93 (range $12.84 – $39.43)
Most-billed visit code 99203
Established Patient
$91.63 typical visit price
range $16.16 – $128.77
Typical copayment $22.90 (range $4.04 – $32.19)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Pharmacy (Home Infusion Therapy Pharmacy)
4300 GRAND AVE
FORT SMITH, AR 72904
Clinic/Center (Multi-Specialty)
4300 GRAND AVE
FORT SMITH, AR 72904
Internal Medicine (Pulmonary Disease)
4300 GRAND AVE
FORT SMITH, AR 72904
Pharmacy (Compounding Pharmacy)
4300 GRAND AVE
FORT SMITH, AR 72904
Nurse Practitioner (Family)
4300 GRAND AVE
FORT SMITH, AR 72904

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Soutnakhon Phandanouvong's NPI number?

The NPI number for Soutnakhon Phandanouvong is 1780273250. It was assigned to this individual provider in the NPPES registry on January 11, 2021.

Where is Soutnakhon Phandanouvong located?

Soutnakhon Phandanouvong practices at 4300 Grand Ave, Fort Smith, AR 72904. The listed phone number is (479) 208-4601.

What is Soutnakhon Phandanouvong's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Soutnakhon Phandanouvong enrolled in Medicare?

Yes. Soutnakhon Phandanouvong is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Soutnakhon Phandanouvong accept?

Health plans from Arkansas Blue Cross and Blue Shield, Health Advantage and Octave list Soutnakhon Phandanouvong as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Soutnakhon Phandanouvong was last updated on June 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.