=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861005878
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEANA RAE DUNGAN APRN-CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2020
-----------------------------------------------------
Last Update Date | 09/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 E JACKSON ST
-----------------------------------------------------
City | HUGO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74743-4229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-326-6423
-----------------------------------------------------
Fax | 580-326-3660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 E JACKSON ST
-----------------------------------------------------
City | HUGO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74743-4229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-326-6423
-----------------------------------------------------
Fax | 580-326-3660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1008142
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------