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General NPI Number Information
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NPI Number | 1184597288
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Entity Type | Individual
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Provider Name | MANUELA DEBACKER APRN
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Gender | Female
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Dates
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Enumeration Date | 09/25/2025
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 630 W SOUTH ST
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City | BENTON
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State | AR
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Zip | 72015-4258
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Country | US
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Telephone | 501-860-7150
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 497
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City | AUGUSTA
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State | AR
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Zip | 72006-0497
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Country | US
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Telephone | 870-347-2534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R101963
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 235311
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License Number State | AR
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