Basic Information
| Provider Information | |||||||||
| NPI: | 1447250345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENSON | ||||||||
| FirstName: | ALYSON | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 E 6TH ST | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 718545207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707796000 | ||||||||
| FaxNumber: | 9037796125 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 E 6TH ST | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 718545207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707796000 | ||||||||
| FaxNumber: | 9037796125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 10/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | E2840 | AR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 143579401 | 05 | TX | MEDICAID | 143890001 | 05 | AR | MEDICAID |