Healthcare Provider Details

I. General information

NPI: 1023082575
Provider Name (Legal Business Name): DEBRA CHARLENE WEST APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S MAIN ST
DE WITT AR
72042-2618
US

IV. Provider business mailing address

402 S MAIN ST
DE WITT AR
72042-2618
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-0079
  • Fax: 870-946-0090
Mailing address:
  • Phone: 870-280-2621
  • Fax: 870-412-4927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01288ANP
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: