Healthcare Provider Details

I. General information

NPI: 1508062340
Provider Name (Legal Business Name): MRS. DEBORAH LEEANN GENTRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. DEBORAH LEEANN KIRKLAND

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 N CHESTER AVE
BAKERSFIELD CA
93308-1770
US

IV. Provider business mailing address

PO BOX 1000
BAKERSFIELD CA
93302-1000
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-1842
  • Fax: 661-868-1841
Mailing address:
  • Phone: 661-868-6601
  • Fax: 661-868-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: