Provider Demographics
NPI:1417985359
Name:MCDOUGALL, DEBRA LORRAINE (NP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LORRAINE
Last Name:MCDOUGALL
Suffix:
Gender:F
Credentials:NP
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 1039
Mailing Address - Street 2:
Mailing Address - City:SPRINGTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:76082-1039
Mailing Address - Country:US
Mailing Address - Phone:817-523-5402
Mailing Address - Fax:817-523-5422
Practice Address - Street 1:308 W HIGHWAY 199
Practice Address - Street 2:
Practice Address - City:SPRINGTOWN
Practice Address - State:TX
Practice Address - Zip Code:76082-2631
Practice Address - Country:US
Practice Address - Phone:817-523-5402
Practice Address - Fax:817-523-5422
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX568161363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8JQ931OtherBCBSTX
TX330725804Medicaid
TX263580YLH5Medicare PIN
TX263580YLH5Medicare PIN