Provider Demographics
NPI:1336428952
Name:PRESTON, DEBRA KAY (FNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:PRESTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 PRE EMPTION RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2018
Mailing Address - Country:US
Mailing Address - Phone:315-789-2153
Mailing Address - Fax:315-789-4781
Practice Address - Street 1:784 PRE EMPTION RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2018
Practice Address - Country:US
Practice Address - Phone:315-789-2153
Practice Address - Fax:315-789-4781
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336802-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily