Provider Demographics
NPI:1689908345
Name:DAWSON, TIMOTHY PAUL (CRNA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PAUL
Last Name:DAWSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-0144
Mailing Address - Country:US
Mailing Address - Phone:501-279-2426
Mailing Address - Fax:501-279-2501
Practice Address - Street 1:119 W. MARKET STREET
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143
Practice Address - Country:US
Practice Address - Phone:501-279-2426
Practice Address - Fax:501-279-2501
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR74293163W00000X
ARC02789367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse