Provider Demographics
NPI:1699480095
Name:WEST, DESA RAE DARNELL (APRN)
Entity type:Individual
Prefix:
First Name:DESA RAE
Middle Name:DARNELL
Last Name:WEST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 HORIZON LN
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-7979
Mailing Address - Country:US
Mailing Address - Phone:479-209-6433
Mailing Address - Fax:
Practice Address - Street 1:3211 N NORTHHILLS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5602
Practice Address - Country:US
Practice Address - Phone:479-463-8740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR223073363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty