Provider Demographics
NPI:1891726758
Name:DYAR, DEBORAH K (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:K
Last Name:DYAR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-0655
Mailing Address - Country:US
Mailing Address - Phone:205-486-5234
Mailing Address - Fax:205-486-5232
Practice Address - Street 1:904 26TH ST
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-1719
Practice Address - Country:US
Practice Address - Phone:205-486-5234
Practice Address - Fax:205-486-5232
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1 026718363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000050938Medicaid
AL000050938Medicaid
S86608Medicare UPIN