Healthcare Provider Details

I. General information

NPI: 1417374596
Provider Name (Legal Business Name): DEBBIE CAUSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 W 12TH ST
LITTLE ROCK AR
72204-1511
US

IV. Provider business mailing address

PO BOX 251970
LITTLE ROCK AR
72225-1970
US

V. Phone/Fax

Practice location:
  • Phone: 501-666-8686
  • Fax:
Mailing address:
  • Phone: 501-666-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL041515
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: