Provider Demographics
NPI:1609854967
Name:FREDERICKS, DEBRA ANNE WALKER (APN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANNE WALKER
Last Name:FREDERICKS
Suffix:
Gender:F
Credentials:APN
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 34120
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-4120
Mailing Address - Country:US
Mailing Address - Phone:775-747-5050
Mailing Address - Fax:775-747-5005
Practice Address - Street 1:890 MILL STREET
Practice Address - Street 2:SUITE 305
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1442
Practice Address - Country:US
Practice Address - Phone:775-657-8449
Practice Address - Fax:775-657-8501
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10811163W00000X, 163WP0808X
NVAPN000640364S00000X, 364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV000640OtherAPN
NV10811OtherRN
NV1609854967Medicaid
NVP45543Medicare UPIN
CA691AMedicare PIN