Provider Demographics
NPI:1013243005
Name:PLEMMONS, DIANNE WALK (APN)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:WALK
Last Name:PLEMMONS
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 1:175 S CORINTH RD
Mailing Address - Street 2:
Mailing Address - City:ASH FLAT
Mailing Address - State:AR
Mailing Address - Zip Code:72513-9658
Mailing Address - Country:US
Mailing Address - Phone:870-834-0683
Mailing Address - Fax:
Practice Address - Street 1:175 S CORINTH RD
Practice Address - Street 2:
Practice Address - City:ASH FLAT
Practice Address - State:AR
Practice Address - Zip Code:72513-9658
Practice Address - Country:US
Practice Address - Phone:870-834-0683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARS02245CNS364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health