Provider Demographics
NPI:1376515080
Name:ATKINSON, DEBRA A (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:A
Other - Last Name:CADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:67 SILVER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-5430
Mailing Address - Country:US
Mailing Address - Phone:573-280-0672
Mailing Address - Fax:
Practice Address - Street 1:1870 BAGNELL DAM BLVD
Practice Address - Street 2:
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-8658
Practice Address - Country:US
Practice Address - Phone:573-365-2318
Practice Address - Fax:573-365-3009
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000162958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
130110OtherBLUE CROSS BLUE SHIELD
937875OtherFIRST HEALTH
MO205061104Medicaid
MOMA4964061OtherMEDICARE PTAN
080165723OtherRR MEDICARE
3156281OtherCIGNA
438746OtherHEALTHLINK
440546366OtherUNITED HEALTHCARE
G25024OtherMERCY
440546366OtherUNITED HEALTHCARE
3156281OtherCIGNA