Healthcare Provider Details

I. General information

NPI: 1265620868
Provider Name (Legal Business Name): DEBRA FAULKNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 N WYATT DR
EL DORADO AR
71730-4189
US

IV. Provider business mailing address

3025 N WYATT DR
EL DORADO AR
71730-4189
US

V. Phone/Fax

Practice location:
  • Phone: 870-310-0321
  • Fax: 870-862-2074
Mailing address:
  • Phone: 870-310-0321
  • Fax: 870-862-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBRA KAY FAULKNER
Title or Position: OWNER
Credential: R.T.
Phone: 870-310-0321