Healthcare Provider Details

I. General information

NPI: 1912631425
Provider Name (Legal Business Name): DANNI DENISE OWENS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1858 GOLDEN GATE AVE
KINGMAN AZ
86401-4055
US

IV. Provider business mailing address

2817 RAWHIDE DR
KINGMAN AZ
86401-7819
US

V. Phone/Fax

Practice location:
  • Phone: 928-529-5349
  • Fax:
Mailing address:
  • Phone: 928-279-5076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRNP280325
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: