Basic Information
Provider Information
NPI: 1003805771
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHIREY
FirstName: DEBORAH
MiddleName: MULLENS
NamePrefix: MRS.
NameSuffix:  
Credential: DNP, FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SHIREY
OtherFirstName: DEBORAH
OtherMiddleName: MULLENS
OtherNamePrefix: MRS.
OtherNameSuffix:  
OtherCredential: DNP, FNP
OtherLastNameType: 5
Mailing Information
Address1: 408 JTL PKWY E
Address2:  
City: SPRINGDALE
State: AR
PostalCode: 727628405
CountryCode: US
TelephoneNumber: 4794228961
FaxNumber:  
Practice Location
Address1: 1706 SE WALTON BLVD.
Address2: OZARK URGENT CARE
City: BENTONVILLE
State: AR
PostalCode: 72712
CountryCode: US
TelephoneNumber: 4794640400
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/17/2005
LastUpdateDate: 07/31/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XA01483ARY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000X549052TXN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
1214132-0505TX MEDICAID
14219975805AR MEDICAID
5W11501ARAR BC/BSOTHER


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