Healthcare Provider Details

I. General information

NPI: 1578667010
Provider Name (Legal Business Name): DANNA SCOTT DEATON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3644 W ST HWY 18 SUITE B
MANILA AR
72442
US

IV. Provider business mailing address

3644 W ST HIGHWAY 18 SUITE B
MANILA AR
72442
US

V. Phone/Fax

Practice location:
  • Phone: 870-561-3300
  • Fax: 870-561-3307
Mailing address:
  • Phone: 870-561-3300
  • Fax: 870-561-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01771
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: