Organization
DEBRA FAULKNER
Active
Other names
Portable Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBRA KAY FAULKNER R.T. (OWNER)
(870) 310-0321
Entity
Organization
Contact information
Practice address
3025 N WYATT DR, EL DORADO, AR 71730-4189
(870) 310-0321
(870) 862-2074
Mailing address
3025 N WYATT DR, EL DORADO, AR 71730-4189
(870) 310-0321
(870) 862-2074
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140983710
—
AR
Enumeration date
10/09/2007
Last updated
08/30/2010
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