NPIMap

Organization Active NPI

De Queen Pediatrics Inc

  • Pediatrics Physician
  • De Queen, AR
National Provider Identifier
1295983237
Registry record updated Apr 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
E-2169 Issued in AR
Legal business name
DE QUEEN PEDIATRICS INC
Practice address
1357 W Collin Raye Dr
De Queen, AR 71832-2946
Phone
(870) 642-4364
NPI assigned
Sep 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Terri A Devlin, M.D.
Title
Owner/Physician
Phone
(870) 642-4364

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X E-2169 AR Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X E-2169 AR

Addresses

Primary practice location

1357 W Collin Raye Dr
De Queen, AR 71832-2946

Mailing address

1357 W Collin Raye Dr
De Queen, AR 71832-2946
Phone (870) 642-4364

Other identifiers 1

IdentifierTypeStateIssuer
170952002MedicaidAR

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398297600000",
    "number": "1295983237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1357 W COLLIN RAYE DR",
            "city": "DE QUEEN",
            "state": "AR",
            "postal_code": "718322946",
            "telephone_number": "870-642-4364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1357 W COLLIN RAYE DR",
            "city": "DE QUEEN",
            "state": "AR",
            "postal_code": "718322946",
            "telephone_number": "870-642-4364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DE QUEEN PEDIATRICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-03",
        "last_updated": "2014-04-24",
        "status": "A",
        "authorized_official_last_name": "DEVLIN",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "870-642-4364",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-2169",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "AR",
            "license": "E-2169",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "170952002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in De Queen, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.