Provider Demographics
NPI:1508153438
Name:LEBOUEF, DEITRA FALGOUT (APRN-BC)
Entity type:Individual
Prefix:MS
First Name:DEITRA
Middle Name:FALGOUT
Last Name:LEBOUEF
Suffix:
Gender:F
Credentials:APRN-BC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6309 N PRESIDENT GEORGE BUSH HWY APT 9202
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-5542
Mailing Address - Country:US
Mailing Address - Phone:972-697-5954
Mailing Address - Fax:469-259-2854
Practice Address - Street 1:5924 W PARKER RD STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6417
Practice Address - Country:US
Practice Address - Phone:972-697-5954
Practice Address - Fax:469-259-2854
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX664217163WW0000X
TXAP1207832083P0011X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1508153438OtherNPI
TXAP120483OtherTEXAS BON