Provider Demographics
NPI:1578667010
Name:SCOTT DEATON, DANNA (APRN)
Entity Type:Individual
Prefix:
First Name:DANNA
Middle Name:
Last Name:SCOTT DEATON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3644 W ST HIGHWAY 18
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANILA
Mailing Address - State:AR
Mailing Address - Zip Code:72442
Mailing Address - Country:US
Mailing Address - Phone:870-561-3300
Mailing Address - Fax:870-561-3307
Practice Address - Street 1:3644 W ST HWY 18
Practice Address - Street 2:SUITE B
Practice Address - City:MANILA
Practice Address - State:AR
Practice Address - Zip Code:72442
Practice Address - Country:US
Practice Address - Phone:870-561-3300
Practice Address - Fax:870-561-3307
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154515758Medicaid
AR154515758Medicaid
ARQ22742Medicare UPIN