Provider Demographics
NPI:1811943954
Name:BIXBY, DEBRA J (NP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:BIXBY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 SHERMAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-8456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:97 SHERMAN DR
Practice Address - Street 2:ST JOHNSBURY PEDIATRICS
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-9280
Practice Address - Country:US
Practice Address - Phone:802-748-5131
Practice Address - Fax:802-748-4237
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0019504363LF0000X
NH048361-23-03363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3072235Medicaid
VT1007933Medicaid
VTNP404401Medicare PIN
S97319Medicare UPIN
VT1007933Medicaid