Healthcare Provider Details

I. General information

NPI: 1518447960
Provider Name (Legal Business Name): DANA KATHRYN CHILDRESS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 HARRISON ST
BATESVILLE AR
72501-7302
US

IV. Provider business mailing address

115 STONEWELL ST
SULPHUR ROCK AR
72579-9201
US

V. Phone/Fax

Practice location:
  • Phone: 870-262-1200
  • Fax:
Mailing address:
  • Phone: 870-384-0251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA005850
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: