Provider Demographics
NPI:1740956721
Name:CALLISON, MARY KATHERINE (APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:CALLISON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARYKATHERINE
Other - Middle Name:MARGARET
Other - Last Name:CALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-1841
Mailing Address - Country:US
Mailing Address - Phone:479-437-3449
Mailing Address - Fax:479-243-0285
Practice Address - Street 1:1723 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7133
Practice Address - Country:US
Practice Address - Phone:888-710-8220
Practice Address - Fax:479-243-0285
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR217155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily