Provider Demographics
NPI:1033847975
Name:DALE, GRACEN LEE (MSN, APRN, NNP-BC)
Entity Type:Individual
Prefix:
First Name:GRACEN
Middle Name:LEE
Last Name:DALE
Suffix:
Gender:F
Credentials:MSN, APRN, NNP-BC
Other - Prefix:
Other - First Name:GRACEN
Other - Middle Name:LEE
Other - Last Name:FELTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:602 OLD HIGHWAY 11 S
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:AR
Mailing Address - Zip Code:72064-9659
Mailing Address - Country:US
Mailing Address - Phone:870-255-5044
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS WAY # 211
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR221005363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal