Provider Demographics
NPI:1669140240
Name:COUSINS, DALLAS JOSEPH (RN,NP)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:JOSEPH
Last Name:COUSINS
Suffix:
Gender:M
Credentials:RN,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 977
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-0977
Mailing Address - Country:US
Mailing Address - Phone:800-634-0201
Mailing Address - Fax:844-442-5123
Practice Address - Street 1:77 GLADE DR
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7140
Practice Address - Country:US
Practice Address - Phone:724-545-2205
Practice Address - Fax:724-545-2600
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN695719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily