Provider Demographics
NPI:1649225343
Name:NEAL, DEANNA JANE (FNPC)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:JANE
Last Name:NEAL
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:MCGEE
Other - Last Name:MCDOUGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNPC
Mailing Address - Street 1:PO BOX 333
Mailing Address - Street 2:
Mailing Address - City:SMACKOVER
Mailing Address - State:AR
Mailing Address - Zip Code:71762
Mailing Address - Country:US
Mailing Address - Phone:318-381-0983
Mailing Address - Fax:318-812-6603
Practice Address - Street 1:1025 MARION HWY
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-9314
Practice Address - Country:US
Practice Address - Phone:318-368-9745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO4117363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1149250Medicaid
4C589Medicare PIN
P80130Medicare UPIN