Provider Demographics
NPI:1114374386
Name:PATTY, DEBRA KAY (RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:PATTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 CEDARCREST DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5707
Mailing Address - Country:US
Mailing Address - Phone:214-507-7471
Mailing Address - Fax:
Practice Address - Street 1:2110 CEDARCREST DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5707
Practice Address - Country:US
Practice Address - Phone:214-507-7471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX578159163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX578159OtherREGISTERED NURSING LICENSE