Healthcare Provider Details

I. General information

NPI: 1861658239
Provider Name (Legal Business Name): DEBORAH L. BARROS ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH L. HOPPER ACNP

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 N 1ST EAST DRIGGS HEALTH CLINIC
DRIGGS ID
83422-5112
US

IV. Provider business mailing address

39 MORNING BREEZE LN
JACKSON TN
38305-9654
US

V. Phone/Fax

Practice location:
  • Phone: 208-354-2302
  • Fax: 208-354-8392
Mailing address:
  • Phone: 731-202-1909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19023A
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-884
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: