| Doctor Name: | DALLAS MAXWELL EARNEST |
| NPI Number: | 1376752832 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 12310 |
| Business Practice Address: | 1015 Lee Dr Ste 13 Clarksdale, MS - 386143619 |
| Business Phone Number: | 6625924170 |
| Business Fax Number: | 6622690226 |
| Mailing Address: | 1015 Lee Dr Ste 13, CLARKSDALE |
| State: | MS |
| Postal Code: | 386143619 |
| Phone Number: | 6625924170 |
| Fax Number: | 6622690226 |
| NPI Enumeration Date: | 05/22/2007 |
| NPI Last Update Date: | 05/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 12310 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |