Provider Demographics
NPI:1164408399
Name:TWYMAN, DEANNA M (APRN, BC, FNP)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:M
Last Name:TWYMAN
Suffix:
Gender:F
Credentials:APRN, BC, FNP
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:MEDLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:MO
Mailing Address - Zip Code:65632-0009
Mailing Address - Country:US
Mailing Address - Phone:417-589-2050
Mailing Address - Fax:417-589-4046
Practice Address - Street 1:301 SOUTH NEWPORT AVENUE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:MO
Practice Address - Zip Code:65632
Practice Address - Country:US
Practice Address - Phone:417-589-2050
Practice Address - Fax:417-589-4046
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN081602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO598899201Medicaid
MO107004OtherBLUE CROSS BLUE SHIELD
A002OtherTRI CARE IDENTIFIER
MORN081602OtherSTATE LICENSE
MO598899201Medicaid