Healthcare Provider Details

I. General information

NPI: 1588255061
Provider Name (Legal Business Name): SUDONNA DYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 02/15/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 WEST TYLER
WEST MEMPHIS AR
72301
US

IV. Provider business mailing address

PO BOX 2192
FORREST CITY AR
72336-2192
US

V. Phone/Fax

Practice location:
  • Phone: 870-735-2737
  • Fax:
Mailing address:
  • Phone: 870-208-8362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR063341
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: