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General NPI Number Information
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NPI Number | 1598289746
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Entity Type | Individual
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Provider Name | KATHRYN N DEACON
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Gender | Female
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Dates
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Enumeration Date | 07/31/2017
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 606 HIGHWAY 365
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City | MAYFLOWER
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State | AR
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Zip | 72106-9595
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Country | US
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Telephone | 501-470-7413
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Fax | 501-470-7415
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Provider Business Mailing Address
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Address Line | PO BOX 9662
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City | CONWAY
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State | AR
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Zip | 72033-9662
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Country | US
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Telephone | 501-852-1363
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Fax | 501-852-1364
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A005258
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License Number State | AR
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