Provider Demographics
NPI:1063053239
Name:LIMBURG, DEANNA
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:LIMBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 COUNTY ROAD 2105 E
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-1701
Mailing Address - Country:US
Mailing Address - Phone:903-445-0771
Mailing Address - Fax:
Practice Address - Street 1:1300 N 6TH ST STE B
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5567
Practice Address - Country:US
Practice Address - Phone:903-297-8798
Practice Address - Fax:903-297-8798
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142831363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health