Provider Demographics
NPI:1407816762
Name:GARRY, NATALIE DEBEAUFORD (GNP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:DEBEAUFORD
Last Name:GARRY
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LYN
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SR ADMIN ASST
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-0624
Mailing Address - Fax:214-645-0078
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-8889
Practice Address - Country:US
Practice Address - Phone:214-648-7204
Practice Address - Fax:214-648-2087
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX659246363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
S83943Medicare UPIN
8020M9Medicare ID - Type Unspecified