Defore, Katie
Defore, Katie is an individual health care provider with primary practice located at 225 E Jackson Ave , Jonesboro AR 72401-3119. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pulmonary Disease, which is considered as her primary health care specialty. Defore, Katie can be contacted via phone (870) 972-4100.Contact Information
Primary practice address
225 E Jackson Ave
Jonesboro AR 72401-3119
Phone: (870) 972-4100
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | E4912 | Arkansas |
Profile Details
| NPI number | 1932220902 |
|---|---|
| LBN Legal business name | Defore, Katie |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 3rd, 2007 |
| Last updated | Apr 13th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1932220902 | NPPES |
| Virginia | Other | 0101245807 | STATE LICENSE |
| Virginia | MEDICAID | 1932220902 | STATE LICENSE |
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