Provider Demographics
NPI:1225328040
Name:GRAVIL, DEBORAH ELKIN (APRN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELKIN
Last Name:GRAVIL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:ELKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 SECOND AVE
Mailing Address - Street 2:STE B1
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101
Mailing Address - Country:US
Mailing Address - Phone:270-782-0151
Mailing Address - Fax:270-782-7528
Practice Address - Street 1:825 SECOND AVE
Practice Address - Street 2:STE B1
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101
Practice Address - Country:US
Practice Address - Phone:270-782-0151
Practice Address - Fax:270-782-7528
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner