Provider Demographics
NPI:1679808695
Name:GAUTHIER, DEBRA ANN (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:FNP-BC
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Other - Credentials:
Mailing Address - Street 1:8825 BEE CAVES RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4720
Mailing Address - Country:US
Mailing Address - Phone:512-328-3376
Mailing Address - Fax:512-306-0222
Practice Address - Street 1:401 RANCH ROAD 620
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734
Practice Address - Country:US
Practice Address - Phone:512-610-0549
Practice Address - Fax:512-306-0222
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2015-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXAP126216363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05670766Medicaid
LA1817597Medicaid
LA3B622Medicare PIN