Provider Demographics
NPI:1033571054
Name:GILL, DEBRA GAIL (RNC, MSN, WHNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:GAIL
Last Name:GILL
Suffix:
Gender:F
Credentials:RNC, MSN, WHNP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:GAIL
Other - Last Name:GRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4892 BRIARTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-9571
Mailing Address - Country:US
Mailing Address - Phone:901-262-0332
Mailing Address - Fax:
Practice Address - Street 1:4892 BRIARTON DR
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-9571
Practice Address - Country:US
Practice Address - Phone:901-262-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866022363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health