1821428640 NPI number — MRS. DEONNA MICHELLE BYNUM FNP

Table of content: MRS. DEONNA MICHELLE BYNUM FNP (NPI 1821428640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821428640 NPI number — MRS. DEONNA MICHELLE BYNUM FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYNUM
Provider First Name:
DEONNA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAPMAN
Provider Other First Name:
DEONNA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821428640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 MEDICAL DRIVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
PALESTINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-729-2428
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 MEDICAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PALESTINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-729-2428
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2013

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: 363L00000X , with the licence number:  766930 , 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)





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