Provider Demographics
NPI:1568580264
Name:HIATT-JENSEN, DEBORAH KATHERINE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:KATHERINE
Last Name:HIATT-JENSEN
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:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-747-2066
Mailing Address - Fax:314-747-7111
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV IM GASTROENTEROLOGY, STE 12B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-2066
Practice Address - Fax:314-747-7111
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014016135363L00000X, 363LF0000X
FLARNP9297394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420018479Medicaid
FLDI847ZMedicare PIN
FL002514700Medicaid
VA00X494N08Medicare PIN