Provider Demographics
NPI:1205315900
Name:MCCOMBS, DAVID LAMONT (APRN)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LAMONT
Last Name:MCCOMBS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 W COMMERCE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-7521
Mailing Address - Country:US
Mailing Address - Phone:501-291-3699
Mailing Address - Fax:
Practice Address - Street 1:606 W COMMERCE DR STE 1
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7521
Practice Address - Country:US
Practice Address - Phone:501-291-3699
Practice Address - Fax:520-476-3792
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005824363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR232728758Medicaid