Provider Demographics
NPI:1639131667
Name:MOTLEY, DEBORAH (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MOTLEY
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:AP BEUTAL STUDENT HEALTH SERVICES
Mailing Address - Street 2:1264 TAMU
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77843-1264
Mailing Address - Country:US
Mailing Address - Phone:979-458-8300
Mailing Address - Fax:979-458-8314
Practice Address - Street 1:AP BEUTAL STUDENT HEALTH SERVICES
Practice Address - Street 2:1264 TAMU
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77843-1264
Practice Address - Country:US
Practice Address - Phone:979-458-8300
Practice Address - Fax:979-458-8314
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX563662363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154467801Medicaid
TX1750470084OtherNPI CLINIC M
TX000951608Medicaid
TX741715140OtherTAX ID
TX1821185299OtherNPI AGENCY
TX1693418-02Medicaid
TX185649401Medicaid
TX000951607Medicaid
TX8N9134OtherBLUE SHIELD
TX8D8395Medicare ID - Type Unspecified
TXS60128Medicare UPIN
TX154467801Medicaid
TX8N9134OtherBLUE SHIELD
TX451981Medicare Oscar/Certification
TX451942Medicare Oscar/Certification