Basic Information
| Provider Information | |||||||||
| NPI: | 1649580473 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLIFTON-JONES | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 860 HIGHWAY 62 E STE 10 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726533200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704243181 | ||||||||
| FaxNumber: | 8704243089 | ||||||||
| Practice Location | |||||||||
| Address1: | 624 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726532955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705081000 | ||||||||
| FaxNumber: | 8704243089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2010 | ||||||||
| LastUpdateDate: | 03/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A03461 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 184875758 | 05 | AR | MEDICAID | A003461 | 01 | AR | ARKANSAS STATE BOARD OF NURSING | OTHER | 283695YWUJ | 01 | AR | MEDICARE | OTHER |