NPIMap

Individual provider Active NPI

Terri Devlin, MD

  • Pediatrics Physician
  • De Queen, AR
National Provider Identifier
1710982285
Registry record updated Apr 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
E2169 Issued in AR
Practice address
1357 W Collin Raye Dr
De Queen, AR 71832-2946
Phone
(870) 642-4364
NPI assigned
Jun 20, 2005
Last updated
Apr 24, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X E2169 AR Primary
General Practice Physician 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 5

IdentifierTypeStateIssuer
100248960AMedicaidOK
186480000OtherARQUALCHOICE
137581001MedicaidAR
100025500AMedicaidOK
5L261OtherARBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060315000111 AR Practitioner - General PracticePractitioner - Pediatric Medicine 5698782787 Reassigns benefits to 1 organization
I20250523001563 TX Practitioner - Pediatric Medicine 5698782787 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
DQH&W Walk in Family Clinic LLC Current Accepting new patients
DQH&W Walk in Family Clinic LLC CurrentSince Mar 16, 2022 Accepting new patients
Arctic Slope Native Association LTD CurrentSince Jan 1, 2023 Accepting new patients
DQH&W Walk in Family Clinic LLC CurrentSince Mar 16, 2022 Accepting new patients
Healthy Connections Inc Past Accepting new patients
Arkansas Children's Medical Group PLLC Pediatrics Past Accepting new patients

Locations

1357 W Collin Raye Dr
De Queen, AR 71832
Phone (870) 642-2000

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398297600000",
    "number": "1710982285",
    "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": {
        "last_name": "DEVLIN",
        "first_name": "TERRI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-20",
        "last_updated": "2014-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E2169",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AR",
            "license": "E-2169",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100248960A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "186480000",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137581001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100025500A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5L261",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in De Queen, AR

Sources for this page

Verify at the official NPI Registry.