Provider Demographics
NPI:1255911186
Name:DELONEY, AZUREE
Entity type:Individual
Prefix:
First Name:AZUREE
Middle Name:
Last Name:DELONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 S ALLIS ST
Mailing Address - Street 2:
Mailing Address - City:ENGLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72046-2030
Mailing Address - Country:US
Mailing Address - Phone:501-800-3211
Mailing Address - Fax:
Practice Address - Street 1:824 S ALLIS ST
Practice Address - Street 2:
Practice Address - City:ENGLAND
Practice Address - State:AR
Practice Address - Zip Code:72046-2030
Practice Address - Country:US
Practice Address - Phone:501-800-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1234Medicaid