Provider Demographics
NPI:1518782127
Name:MITCHUSSON, DANA SUE (RN)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:SUE
Last Name:MITCHUSSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:SUE
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4504 PENNPOINTE PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-3677
Mailing Address - Country:US
Mailing Address - Phone:870-270-0955
Mailing Address - Fax:866-716-1451
Practice Address - Street 1:10800 FINANCIAL CENTRE PKWY STE 485
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3539
Practice Address - Country:US
Practice Address - Phone:501-255-7375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR053340163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health