Provider Demographics
NPI:1811659576
Name:CONNER, DEANA KAY (LPN)
Entity type:Individual
Prefix:MRS
First Name:DEANA
Middle Name:KAY
Last Name:CONNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 EVENING SUNSET CIR
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72132-8012
Mailing Address - Country:US
Mailing Address - Phone:870-370-6819
Mailing Address - Fax:
Practice Address - Street 1:3450 W 34TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5508
Practice Address - Country:US
Practice Address - Phone:870-534-6067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL037659164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse