Healthcare Provider Details

I. General information

NPI: 1134974553
Provider Name (Legal Business Name): WEST POINT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S MAIN ST
DE WITT AR
72042-2618
US

IV. Provider business mailing address

PO BOX 286
DE WITT AR
72042-0286
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-0079
  • Fax: 870-946-0090
Mailing address:
  • Phone: 870-946-0198
  • Fax: 870-946-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBRA CHARLENE WEST
Title or Position: APRN
Credential: APRN
Phone: 870-946-0198