Provider Demographics
NPI:1386934206
Name:DAVIS, DEBRA A
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 HWY 67 S BLDG 4
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015
Mailing Address - Country:US
Mailing Address - Phone:501-315-3344
Mailing Address - Fax:501-660-6838
Practice Address - Street 1:6701 HWY 67 S. BLDG 4
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015
Practice Address - Country:US
Practice Address - Phone:501-315-3344
Practice Address - Fax:501-660-6838
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator