Provider Demographics
NPI:1265949895
Name:MICHAELIS, DEANNA (FNP)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:MICHAELIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 HWY 238
Mailing Address - Street 2:
Mailing Address - City:MORO
Mailing Address - State:AR
Mailing Address - Zip Code:72368
Mailing Address - Country:US
Mailing Address - Phone:870-317-5676
Mailing Address - Fax:
Practice Address - Street 1:114 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-3327
Practice Address - Country:US
Practice Address - Phone:870-970-3340
Practice Address - Fax:870-383-3334
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily