Provider Demographics
NPI:1942915517
Name:SAMANTHA DEVAZIER APRN PLLC
Entity Type:Organization
Organization Name:SAMANTHA DEVAZIER APRN PLLC
Other - Org Name:DELTA FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:870-594-8012
Mailing Address - Street 1:1111 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-2150
Mailing Address - Country:US
Mailing Address - Phone:870-594-8012
Mailing Address - Fax:870-594-8013
Practice Address - Street 1:1111 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2150
Practice Address - Country:US
Practice Address - Phone:870-594-8012
Practice Address - Fax:870-594-8013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty