Provider Demographics
NPI:1396559159
Name:TURNER, DETAVION
Entity type:Individual
Prefix:
First Name:DETAVION
Middle Name:
Last Name:TURNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2192
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336-2192
Mailing Address - Country:US
Mailing Address - Phone:870-208-8362
Mailing Address - Fax:870-662-6826
Practice Address - Street 1:1501 DAWSON RD
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2088
Practice Address - Country:US
Practice Address - Phone:870-630-2328
Practice Address - Fax:870-662-6826
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator