1366874505 NPI number — MS. DEBORAH DARLENE VANOVER FNP-C

Table of content: MS. DEBORAH DARLENE VANOVER FNP-C (NPI 1366874505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366874505 NPI number — MS. DEBORAH DARLENE VANOVER FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANOVER
Provider First Name:
DEBORAH
Provider Middle Name:
DARLENE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WESTFALL
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
DARLENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366874505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
919 HIDDEN RDG
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75038-3813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-282-2711
Provider Business Mailing Address Fax Number:
469-282-2609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2246 NALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT NECHES
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77651-4208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-722-4400
Provider Business Practice Location Address Fax Number:
409-722-4409
Provider Enumeration Date:
07/30/2013

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:  597450 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: AP123889 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 331471808 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P02601531 . This is a "MCRR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1K1915 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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