Provider Demographics
NPI:1396776514
Name:HOOVER, DEBORAH A (DNP,FNP-BC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:HOOVER
Suffix:
Gender:F
Credentials:DNP,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4077 PEMBERTON SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5580
Mailing Address - Country:US
Mailing Address - Phone:601-638-8600
Mailing Address - Fax:601-638-8661
Practice Address - Street 1:4077 PEMBERTON SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5580
Practice Address - Country:US
Practice Address - Phone:601-638-8600
Practice Address - Fax:601-638-8661
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR764566363L00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125362Medicaid
LA1140503Medicaid
LA1140503Medicaid
MS512I500373Medicare PIN
MS500027752Medicare PIN
MS3021502673Medicare UPIN
FMP59646Medicare UPIN