Provider Demographics
NPI:1811283906
Name:GULLETTE, DONNA LYNN (APN, ACNP-BC)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LYNN
Last Name:GULLETTE
Suffix:
Gender:F
Credentials:APN, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1811 RAHLING RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4677
Mailing Address - Country:US
Mailing Address - Phone:501-614-2340
Mailing Address - Fax:501-614-2349
Practice Address - Street 1:1811 RAHLING RD
Practice Address - Street 2:SUITE 120
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4677
Practice Address - Country:US
Practice Address - Phone:501-614-2340
Practice Address - Fax:501-614-2349
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA03545363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR198195758Medicaid