1861658239 NPI number — MRS. DEBORAH L. BARROS ACNP

Table of content: RALPH F GONZALEZ M.D. (NPI 1043373988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861658239 NPI number — MRS. DEBORAH L. BARROS ACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARROS
Provider First Name:
DEBORAH
Provider Middle Name:
L.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ACNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOPPER
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ACNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861658239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 MORNING BREEZE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38305-9654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-202-1909
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
283 N 1ST EAST
Provider Second Line Business Practice Location Address:
DRIGGS HEALTH CLINIC
Provider Business Practice Location Address City Name:
DRIGGS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83422-5112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-354-2302
Provider Business Practice Location Address Fax Number:
208-354-8392
Provider Enumeration Date:
08/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  19023A , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: NP-884 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000010169260 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com