Provider Demographics
NPI:1942434758
Name:RADAFORD, DEBORAH (FNP-C, AAHIVMS)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:RADAFORD
Suffix:
Gender:F
Credentials:FNP-C, AAHIVMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S MAIN ST
Mailing Address - Street 2:ROOM 1500
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4802
Mailing Address - Country:US
Mailing Address - Phone:817-321-4850
Mailing Address - Fax:817-321-4809
Practice Address - Street 1:1101 S MAIN ST
Practice Address - Street 2:ROOM 1500
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4802
Practice Address - Country:US
Practice Address - Phone:817-321-4850
Practice Address - Fax:817-321-4809
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX267817YKQLMedicare PIN
TX267817YKPWMedicare PIN
TX267817YKP5Medicare PIN