Basic Information
| Provider Information | |||||||||
| NPI: | 1972259745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOUSH | ||||||||
| FirstName: | DYLAN | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 283 HELTER RD | ||||||||
| Address2: | |||||||||
| City: | POCAHONTAS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724551451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703785923 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4800 E JOHNSON AVE | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724058413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709361000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2022 | ||||||||
| LastUpdateDate: | 06/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 367500000X | 220394 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.