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General NPI Number Information
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NPI Number | 1174017917
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Entity Type | Individual
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Provider Name | KATHRYN RAE DUTTON DNP, AGACNP
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Gender | Female
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Dates
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Enumeration Date | 06/15/2018
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 2710 S RIFE MEDICAL LN
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City | ROGERS
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State | AR
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Zip | 72758
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Country | US
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Telephone | 479-338-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 S RIFE MEDICAL LN
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City | ROGERS
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State | AR
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Zip | 72758-1452
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Country | US
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Telephone | 479-338-2142
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | A005837
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License Number State | AR
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