Provider Demographics
NPI:1104936509
Name:HUNTER, DEBRA K (PA)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:HUNTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MIRKES PKWY
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2972
Mailing Address - Country:US
Mailing Address - Phone:972-849-0825
Mailing Address - Fax:
Practice Address - Street 1:700 MIRKES PKWY
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115
Practice Address - Country:US
Practice Address - Phone:972-849-0825
Practice Address - Fax:972-291-6076
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02284363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191295808Medicaid
TX191295808Medicaid
TXTXB123417Medicare PIN