Provider Demographics
NPI:1497993950
Name:CARLISLE, DEBORAH ANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-0306
Mailing Address - Country:US
Mailing Address - Phone:334-289-9982
Mailing Address - Fax:334-287-0479
Practice Address - Street 1:951 US HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-4102
Practice Address - Country:US
Practice Address - Phone:334-289-9982
Practice Address - Fax:334-287-0479
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-064520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051009367OtherBLUE CROSS BLUE SHIELD OF ALABAMA