Provider Demographics
NPI:1639229339
Name:BURNSIDE, RANA DIANE (APN)
Entity type:Individual
Prefix:MRS
First Name:RANA
Middle Name:DIANE
Last Name:BURNSIDE
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 1:204 TAMARIND ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-4818
Mailing Address - Country:US
Mailing Address - Phone:870-741-7161
Mailing Address - Fax:
Practice Address - Street 1:520 N PINE ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3442
Practice Address - Country:US
Practice Address - Phone:870-741-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145381758Medicaid
AR500024097OtherRAILROAD MEDICARE
AR145381758Medicaid
5W144Medicare PIN