Provider Demographics
NPI:1053926881
Name:DEVORE, MAKAYLA RAE (LPN)
Entity type:Individual
Prefix:MISS
First Name:MAKAYLA
Middle Name:RAE
Last Name:DEVORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 DEVELOPMENT DR.
Mailing Address - Street 2:
Mailing Address - City:YELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72687
Mailing Address - Country:US
Mailing Address - Phone:870-688-9812
Mailing Address - Fax:
Practice Address - Street 1:81 DEVELOPMENT DR.
Practice Address - Street 2:
Practice Address - City:YELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72687
Practice Address - Country:US
Practice Address - Phone:870-688-9812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR212684164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse