Provider Demographics
NPI:1629317813
Name:DEFREITAS-COOK, DEBRA DEANNA (APN-BC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:DEANNA
Last Name:DEFREITAS-COOK
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 N BOB YOUNKIN DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3927
Mailing Address - Country:US
Mailing Address - Phone:479-463-8888
Mailing Address - Fax:479-463-8889
Practice Address - Street 1:3017 N BOB YOUNKIN DR STE 102
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3927
Practice Address - Country:US
Practice Address - Phone:479-463-8888
Practice Address - Fax:479-463-8889
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003817363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner