Provider Demographics
NPI:1902829302
Name:DEERING, LETA R (FNP)
Entity Type:Individual
Prefix:MS
First Name:LETA
Middle Name:R
Last Name:DEERING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2634 GOLLIHAR RD
Mailing Address - Street 2:STE C
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-5200
Mailing Address - Country:US
Mailing Address - Phone:361-853-3995
Mailing Address - Fax:361-853-9702
Practice Address - Street 1:2634 GOLLIHAR RD
Practice Address - Street 2:STE C
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-5200
Practice Address - Country:US
Practice Address - Phone:361-853-3995
Practice Address - Fax:361-853-9702
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP109662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM52353354Medicaid
TX181868406Medicaid
TX2983009YLPSOtherWELLMED PTAN
TX181868406Medicaid