Provider Demographics
NPI:1790838266
Name:SMITH, DEBRA LYNN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:608 GATEWAY CENTRAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654
Mailing Address - Country:US
Mailing Address - Phone:830-693-2005
Mailing Address - Fax:830-798-2006
Practice Address - Street 1:608 GATEWAY CENTRAL
Practice Address - Street 2:SUITE 100
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654
Practice Address - Country:US
Practice Address - Phone:830-693-2005
Practice Address - Fax:830-798-2006
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1179363AM0700X
TXPA06460363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1179OtherSTATE LICENSE
COMS0464470OtherDEA