Provider Demographics
NPI:1104306588
Name:DEBOOSERIE, ALLISON ANNAKAY (APRN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANNAKAY
Last Name:DEBOOSERIE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:ANNAKAY
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3196 MCKENSIE DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-4989
Mailing Address - Country:US
Mailing Address - Phone:870-299-2285
Mailing Address - Fax:
Practice Address - Street 1:9500 KANIS RD STE 501
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6389
Practice Address - Country:US
Practice Address - Phone:501-227-9080
Practice Address - Fax:501-227-0490
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2024-11-25
Deactivation Date:2024-11-11
Deactivation Code:
Reactivation Date:2024-11-25
Provider Licenses
StateLicense IDTaxonomies
AR230356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily