Provider Demographics
NPI:1871688663
Name:EICHHORN, DEZRA J (APN)
Entity Type:Individual
Prefix:MRS
First Name:DEZRA
Middle Name:J
Last Name:EICHHORN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1144
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143
Mailing Address - Country:US
Mailing Address - Phone:501-230-9181
Mailing Address - Fax:501-268-0134
Practice Address - Street 1:1120 S. MAIN ST.
Practice Address - Street 2:SUITE C
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143
Practice Address - Country:US
Practice Address - Phone:501-230-9181
Practice Address - Fax:501-268-0134
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01585363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR179293758Medicaid
AR179293758Medicaid