Healthcare Provider Details

I. General information

NPI: 1689908345
Provider Name (Legal Business Name): TIMOTHY PAUL DAWSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W. MARKET STREET
SEARCY AR
72143
US

IV. Provider business mailing address

PO BOX 144
SEARCY AR
72145-0144
US

V. Phone/Fax

Practice location:
  • Phone: 501-279-2426
  • Fax: 501-279-2501
Mailing address:
  • Phone: 501-279-2426
  • Fax: 501-279-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR74293
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC02789
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: