Healthcare Provider Details

I. General information

NPI: 1043776727
Provider Name (Legal Business Name): DONIELLE KAY SWANSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 09/08/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HWY 65 NORTH SUITE 110
HARRISON AR
72601
US

IV. Provider business mailing address

1401 HWY 65 NORTH SUITE 110
HARRISON AR
72601
US

V. Phone/Fax

Practice location:
  • Phone: 704-144-0228
  • Fax: 870-414-4023
Mailing address:
  • Phone: 870-414-4022
  • Fax: 870-414-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2018044680
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: