Healthcare Provider Details

I. General information

NPI: 1558636704
Provider Name (Legal Business Name): DANNA LEA GUNTHARP APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 W MAIN ST
WALNUT RIDGE AR
72476-1430
US

IV. Provider business mailing address

PO BOX 839
WALNUT RIDGE AR
72476-0839
US

V. Phone/Fax

Practice location:
  • Phone: 870-886-3211
  • Fax: 870-886-3616
Mailing address:
  • Phone: 870-886-3211
  • Fax: 870-886-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR065435
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004078
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: