Provider Demographics
NPI:1003805771
Name:SHIREY, DEBORAH MULLENS (DNP, FNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:MULLENS
Last Name:SHIREY
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:MULLENS
Other - Last Name:SHIREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, FNP
Mailing Address - Street 1:408 JTL PKWY E
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-8405
Mailing Address - Country:US
Mailing Address - Phone:479-422-8961
Mailing Address - Fax:
Practice Address - Street 1:1706 SE WALTON BLVD.
Practice Address - Street 2:OZARK URGENT CARE
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712
Practice Address - Country:US
Practice Address - Phone:479-464-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX549052363LF0000X
ARA01483363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1214132-05Medicaid
AR5W115OtherAR BC/BS
AR142199758Medicaid
TX8A3603Medicare ID - Type Unspecified
AR5A9916750Medicare PIN
TX1214132-05Medicaid
AR142199758Medicaid
AR5A991Medicare PIN
AR5A991B836Medicare PIN
AR5A991G112Medicare PIN
AR5A991B809Medicare PIN