Provider Demographics
NPI:1275529893
Name:FAULKNER, DEBRA KAY (RT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-3075
Mailing Address - Country:US
Mailing Address - Phone:870-310-0321
Mailing Address - Fax:
Practice Address - Street 1:3025 N WYATT DR
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4189
Practice Address - Country:US
Practice Address - Phone:870-862-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F908Medicare PIN