Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | A01099 | AR |
NPI | 1053323899 |
---|---|
Provider Name | Mrs. Jacqueline Lee Deeds-Buford |
First Address | Alma, AR 72921-7752 |
Second Address | Fayetteville, AR 72703-1944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 08/07/2007 |