Provider Demographics
NPI:1114086485
Name:MULLIGAN-TIMER, DEBORAH DAVIS (FNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:DAVIS
Last Name:MULLIGAN-TIMER
Suffix:
Gender:F
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 N SHORE RD PECK LK
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-7017
Mailing Address - Country:US
Mailing Address - Phone:518-339-7930
Mailing Address - Fax:
Practice Address - Street 1:2452 ROUTE 9
Practice Address - Street 2:SUITE 205
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020
Practice Address - Country:US
Practice Address - Phone:518-245-3837
Practice Address - Fax:518-248-3840
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333669-1363LF0000X
NYF401249-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily