Provider Demographics
NPI:1124089891
Name:WINBERRY, DEBORAH KAY (PA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:WINBERRY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 MALL RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1641
Mailing Address - Country:US
Mailing Address - Phone:256-767-2702
Mailing Address - Fax:
Practice Address - Street 1:2908 MALL RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1641
Practice Address - Country:US
Practice Address - Phone:256-767-2702
Practice Address - Fax:256-718-6047
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.373363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPA.373OtherMEDICAL LICENSE