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General NPI Number Information
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NPI Number | 1629317813
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Entity Type | Individual
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Provider Name | DEBRA DEANNA DEFREITAS-COOK APN-BC
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Gender | Female
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 08/28/2014
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Provider Practice Location Address
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Address Line | 3017 N BOB YOUNKIN DR STE 102
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3927
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Country | US
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Telephone | 479-463-8888
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Fax | 479-463-8889
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Provider Business Mailing Address
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Address Line | 3017 N BOB YOUNKIN DR STE 102
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3927
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Country | US
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Telephone | 479-463-8888
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Fax | 479-463-8889
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | A003817
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License Number State | AR
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