Provider Demographics
NPI:1659738250
Name:PULLIAM, DANA KIM (ARPN, NP-C)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:KIM
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:ARPN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S E ST STE A
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4316
Mailing Address - Country:US
Mailing Address - Phone:479-431-3425
Mailing Address - Fax:479-783-0261
Practice Address - Street 1:301 S E ST STE A
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4316
Practice Address - Country:US
Practice Address - Phone:479-431-3425
Practice Address - Fax:479-783-0261
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004618363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily