Healthcare Provider Details

I. General information

NPI: 1003645268
Provider Name (Legal Business Name): DEBRA VENOLA DAVIS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. DEBRA VENOLA PRICE

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 S CATALPA ST STE 9
PINE BLUFF AR
71603-4869
US

IV. Provider business mailing address

3104 S CATALPA ST STE 9
PINE BLUFF AR
71603-4869
US

V. Phone/Fax

Practice location:
  • Phone: 870-718-2822
  • Fax:
Mailing address:
  • Phone: 870-718-2822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022141296
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: