Healthcare Provider Details

I. General information

NPI: 1003579418
Provider Name (Legal Business Name): KATHERINE ELIZABETH DUNHAM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 VOLUNTEER PKWY
CLINTON AR
72031-8001
US

IV. Provider business mailing address

175 VOLUNTEER PKWY
CLINTON AR
72031-8001
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-3388
  • Fax: 501-745-3006
Mailing address:
  • Phone: 501-757-1385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number214892
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: