Provider Demographics
NPI:1861595902
Name:MITCHELL, DEBORAH R (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:R
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:ATTN BILLING
Mailing Address - City:DENSION
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:903-416-6200
Mailing Address - Fax:
Practice Address - Street 1:5012 S US HIGHWAY 75
Practice Address - Street 2:SUITE 300
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4587
Practice Address - Country:US
Practice Address - Phone:903-416-6200
Practice Address - Fax:903-416-6201
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP107319363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200571280AMedicaid
TX2138804205Medicaid
TX387667YMCMMedicare PIN
OK200571280AMedicaid