Provider Demographics
NPI:1679808695
Name:GAUTHIER, DEBRA ANN (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-1302
Mailing Address - Country:US
Mailing Address - Phone:512-930-3909
Mailing Address - Fax:512-869-5868
Practice Address - Street 1:4513 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-1302
Practice Address - Country:US
Practice Address - Phone:512-930-3909
Practice Address - Fax:128-695-5868
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126216363LF0000X
TX858302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1817597Medicaid
MS05670766Medicaid
LA3B622Medicare PIN