Provider Demographics
NPI:1821428640
Name:BYNUM, DEONNA MICHELLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DEONNA
Middle Name:MICHELLE
Last Name:BYNUM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:DEONNA
Other - Middle Name:MICHELLE
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:126 MEDICAL DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801
Mailing Address - Country:US
Mailing Address - Phone:903-729-2428
Mailing Address - Fax:
Practice Address - Street 1:126 MEDICAL DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801
Practice Address - Country:US
Practice Address - Phone:903-729-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX766930363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner