Provider Demographics
NPI:1598947590
Name:ANDERSON, DEBORAH T (NP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:T
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6101 U S HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7158
Mailing Address - Country:US
Mailing Address - Phone:601-909-6240
Mailing Address - Fax:601-909-6289
Practice Address - Street 1:6101 U S HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7158
Practice Address - Country:US
Practice Address - Phone:601-909-6240
Practice Address - Fax:601-909-6289
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857606363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner