Basic Information
| Provider Information | |||||||||
| NPI: | 1669140240 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COUSINS | ||||||||
| FirstName: | DALLAS | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | RN,NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 977 | ||||||||
| Address2: | |||||||||
| City: | KITTANNING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162010977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006340201 | ||||||||
| FaxNumber: | 8444425123 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 GLADE DR | ||||||||
| Address2: | |||||||||
| City: | KITTANNING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162017140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245452205 | ||||||||
| FaxNumber: | 7245452600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2021 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN695719 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.