Provider Demographics
NPI:1497719702
Name:DEVORE, JANET KAY (APN, MNSC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:KAY
Last Name:DEVORE
Suffix:
Gender:F
Credentials:APN, MNSC
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:KAY
Other - Last Name:FAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11197 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-8829
Mailing Address - Country:US
Mailing Address - Phone:479-839-3724
Mailing Address - Fax:
Practice Address - Street 1:125 E TOWNSHIP STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2817
Practice Address - Country:US
Practice Address - Phone:479-443-7791
Practice Address - Fax:479-443-5761
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01074363LF0000X
ARR30315163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
S53243Medicare UPIN