Provider Demographics
NPI:1932581667
Name:RUSSELL, DEBORAH LYNN (BSN, MSN, FNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:BSN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 E MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-4834
Mailing Address - Country:US
Mailing Address - Phone:423-494-6439
Mailing Address - Fax:
Practice Address - Street 1:183 E MEADOWBROOK LN
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-4834
Practice Address - Country:US
Practice Address - Phone:423-494-6439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000019514363LF0000X
TN19514363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily