Provider Demographics
NPI:1699712877
Name:RIVERSTAR, DEBORAH LINDSEY (FNP-BC, RN)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LINDSEY
Last Name:RIVERSTAR
Suffix:
Gender:F
Credentials:FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8312 HANBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-3010
Mailing Address - Country:US
Mailing Address - Phone:512-917-7333
Mailing Address - Fax:
Practice Address - Street 1:8312 HANBRIDGE LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78736-3010
Practice Address - Country:US
Practice Address - Phone:512-917-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX637801363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y4035OtherBCBS PVN
TX4723OtherTSBNE NUMBER
TXNO139492OtherDPS
TXNO139492OtherDPS
TX8J9316Medicare PIN
TXMR1939656OtherDEA
TXTXB149546Medicare UPIN
TX8Y4035OtherBCBS PVN