Provider Demographics
NPI:1831117084
Name:DENTON, KATHRYN LORI (ANP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LORI
Last Name:DENTON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3150
Mailing Address - Country:US
Mailing Address - Phone:870-207-7555
Mailing Address - Fax:870-336-5083
Practice Address - Street 1:303 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3150
Practice Address - Country:US
Practice Address - Phone:870-207-7555
Practice Address - Fax:870-336-5083
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAO1269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR133759758Medicaid
AR133759758Medicaid
AR5U128Medicare ID - Type Unspecified