Provider Demographics
NPI:1295954808
Name:GOSSETT, DEBORAH KAY (APN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:GOSSETT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PETTWAY CIR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-3729
Mailing Address - Country:US
Mailing Address - Phone:479-996-7269
Mailing Address - Fax:
Practice Address - Street 1:3112 S 70TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5068
Practice Address - Country:US
Practice Address - Phone:479-452-8600
Practice Address - Fax:479-452-7844
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR188588363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR440121701Medicaid