Provider Demographics
NPI:1861658239
Name:BARROS, DEBORAH L (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:L
Last Name:BARROS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:L
Other - Last Name:HOPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:39 MORNING BREEZE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9654
Mailing Address - Country:US
Mailing Address - Phone:731-202-1909
Mailing Address - Fax:
Practice Address - Street 1:283 N 1ST EAST
Practice Address - Street 2:DRIGGS HEALTH CLINIC
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5112
Practice Address - Country:US
Practice Address - Phone:208-354-2302
Practice Address - Fax:208-354-8392
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID19023A363LF0000X
IDNP-884363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010169260Medicaid