MEDICARE: DEBRA FAULKNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265620868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBRA FAULKNER

Provider Business Mailing Address
First Line	:	3025 N WYATT DR
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4189
Country	:	US
Telephone Number	:	870-310-0321
Fax Number	:	870-862-2074

Provider Business Practice Location Address
First Line	:	3025 N WYATT DR
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4189
Country	:	US
Telephone Number	:	870-310-0321
Fax Number	:	870-862-2074

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DEBRA KAY FAULKNER
Credential	:	R.T.
Telephone Number	:	870-310-0321

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	08/30/2010

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Directions to “DEBRA FAULKNER ” Practice Location

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