Provider Demographics
NPI:1205194750
Name:MCCARTY, DEBRA LEE (CHP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEE
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SPRUCE STREET
Mailing Address - Street 2:
Mailing Address - City:FORT YUKON
Mailing Address - State:AK
Mailing Address - Zip Code:99740
Mailing Address - Country:US
Mailing Address - Phone:907-662-7523
Mailing Address - Fax:907-662-2709
Practice Address - Street 1:1 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:FORT YUKON
Practice Address - State:AK
Practice Address - Zip Code:99740
Practice Address - Country:US
Practice Address - Phone:907-662-2460
Practice Address - Fax:907-662-2709
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK92-0134670172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker