Provider Demographics
NPI:1437256484
Name:ZACHEUS, DEBORAH S (NP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:ZACHEUS
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 1:130 STATE HIGHWAY 173 N UNIT 519
Mailing Address - Street 2:
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003-8025
Mailing Address - Country:US
Mailing Address - Phone:830-796-3448
Mailing Address - Fax:830-796-3840
Practice Address - Street 1:1116 12TH ST # 3
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003-3454
Practice Address - Country:US
Practice Address - Phone:830-796-3448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX507719363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092909302Medicaid
86N466OtherBCBS
TX500004694OtherRAILROAD MEDICARE
TX092909302Medicaid
TX500004694OtherRAILROAD MEDICARE
S63173Medicare UPIN
TX500004694Medicare PIN