Provider Demographics
NPI:1023146164
Name:SHAW, DEBRA KAY (ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:KAY
Last Name:SHAW
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:KAY
Other - Last Name:SEXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:1301 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-6901
Mailing Address - Country:US
Mailing Address - Phone:765-962-0713
Mailing Address - Fax:765-939-3950
Practice Address - Street 1:1301 S 8TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-6901
Practice Address - Country:US
Practice Address - Phone:765-939-3947
Practice Address - Fax:765-939-3950
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001346A363LA2200X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28084221AOtherREGISTERED NURSE #
MS6244797OtherDEA NUMBER
INMS0832647OtherDEA #
IN906050EMedicare PIN