Provider Demographics
NPI:1023082575
Name:WEST, DEBRA CHARLENE (APN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:CHARLENE
Last Name:WEST
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 1:402 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-2618
Mailing Address - Country:US
Mailing Address - Phone:870-280-2621
Mailing Address - Fax:870-412-4927
Practice Address - Street 1:402 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-2618
Practice Address - Country:US
Practice Address - Phone:870-946-0079
Practice Address - Fax:870-946-0090
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01288ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134274758Medicaid
AR134274758Medicaid