Provider Demographics
NPI:1609976174
Name:CONNELL, CATHERINE SUE (APN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SUE
Last Name:CONNELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 SAWTOOTH OAK STREET
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7951
Mailing Address - Country:US
Mailing Address - Phone:501-520-6283
Mailing Address - Fax:501-520-6291
Practice Address - Street 1:177 SAWTOOTH OAK STREET
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7951
Practice Address - Country:US
Practice Address - Phone:501-520-6283
Practice Address - Fax:501-520-6291
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136493758Medicaid
ARS61958Medicare UPIN
AR5U058Medicare ID - Type Unspecified