Provider Demographics
NPI:1821123779
Name:BILBO, DEBRA K (ACNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:BILBO
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 ARKANSAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1604
Mailing Address - Country:US
Mailing Address - Phone:870-773-7246
Mailing Address - Fax:870-773-8316
Practice Address - Street 1:1414 ARKANSAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1604
Practice Address - Country:US
Practice Address - Phone:870-773-7246
Practice Address - Fax:870-773-8316
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX614189363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR85013OtherBCBS OF AR
TX8Y3646OtherBCBS TEXAS
TX195339001Medicaid
OK200233400AMedicaid
TX8Y3646OtherBCBS TEXAS