Healthcare Provider Details

I. General information

NPI: 1649225343
Provider Name (Legal Business Name): DEANNA JANE NEAL FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEANNA MCGEE MCDOUGAL FNPC

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MARION HWY
FARMERVILLE LA
71241-9314
US

IV. Provider business mailing address

PO BOX 333
SMACKOVER AR
71762
US

V. Phone/Fax

Practice location:
  • Phone: 318-368-9745
  • Fax:
Mailing address:
  • Phone: 318-381-0983
  • Fax: 318-812-6603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO4117
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: