Provider Demographics
NPI:1942378435
Name:WARREN, DANA KAYE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:KAYE
Last Name:WARREN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:KAYE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:500 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-5204
Mailing Address - Country:US
Mailing Address - Phone:479-968-5048
Mailing Address - Fax:
Practice Address - Street 1:500 E 3RD ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-5204
Practice Address - Country:US
Practice Address - Phone:479-968-5048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1333174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist