Provider Demographics
NPI:1508153438
Name:LEBOUEF, DEITRA FALGOUT (APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:DEITRA
Middle Name:FALGOUT
Last Name:LEBOUEF
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13140 COIT RD STE 405A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5755
Mailing Address - Country:US
Mailing Address - Phone:214-272-7829
Mailing Address - Fax:214-777-9895
Practice Address - Street 1:13140 COIT RD STE 405A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5755
Practice Address - Country:US
Practice Address - Phone:214-272-7829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120783363LF0000X
TX664217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1508153438OtherNPI
TXAP120483OtherTEXAS BON