Provider Demographics
NPI:1518447960
Name:CHILDRESS, DANA KATHRYN (CNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:KATHRYN
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 STONEWELL ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72579-9201
Mailing Address - Country:US
Mailing Address - Phone:870-384-0251
Mailing Address - Fax:
Practice Address - Street 1:1695 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7302
Practice Address - Country:US
Practice Address - Phone:870-262-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005850363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner