Healthcare Provider Details

I. General information

NPI: 1174017917
Provider Name (Legal Business Name): KATHRYN RAE DUTTON DNP, AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN FISHER

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 GRANT ST
MALVERN AR
72104-4700
US

IV. Provider business mailing address

223 GRANT ST
MALVERN AR
72104-4700
US

V. Phone/Fax

Practice location:
  • Phone: 501-337-9031
  • Fax: 479-339-8890
Mailing address:
  • Phone: 479-783-4672
  • Fax: 479-339-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberA005837
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: