Provider Demographics
NPI:1477737567
Name:MYERS, DEBORAH JO (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JO
Last Name:MYERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2876
Mailing Address - Country:US
Mailing Address - Phone:704-664-7494
Mailing Address - Fax:704-664-9642
Practice Address - Street 1:550 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2876
Practice Address - Country:US
Practice Address - Phone:704-664-7494
Practice Address - Fax:704-664-9642
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-03875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003923Medicaid
NC2813706Medicare PIN