Individual
AMY DEATHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 MEDICAL DR STE 100, PARAGOULD, AR 72450-4005
(870) 932-0399
Mailing address
1 MEDICAL DR STE 100, PARAGOULD, AR 72450-4005
(870) 932-0399
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2014012328
AR
Other
Enumeration date
09/06/2014
Last updated
03/31/2025
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