Provider Demographics
NPI:1225121387
Name:WINTER, DEBORAH KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:WINTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:BLACK HAWK
Mailing Address - State:SD
Mailing Address - Zip Code:57718-0537
Mailing Address - Country:US
Mailing Address - Phone:605-787-6675
Mailing Address - Fax:605-718-1098
Practice Address - Street 1:3625 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6015
Practice Address - Country:US
Practice Address - Phone:605-718-1095
Practice Address - Fax:605-718-1098
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant