Provider Demographics
NPI:1962065664
Name:AVERY, DEBRA KAY (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:KAY
Last Name:AVERY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SW 2ND ST STE C
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3800
Mailing Address - Country:US
Mailing Address - Phone:719-900-8546
Mailing Address - Fax:
Practice Address - Street 1:313 SW 2ND ST STE C
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3800
Practice Address - Country:US
Practice Address - Phone:719-900-8546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994619-NP363LP0808X
OR202100308NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty