Healthcare Provider Details

I. General information

NPI: 1619978467
Provider Name (Legal Business Name): DEBORAH MYERS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 PINE RIDGE RD
WHITE BIRD ID
83554-9401
US

IV. Provider business mailing address

7702 MEANY AVE STE 101
BAKERSFIELD CA
93308-5199
US

V. Phone/Fax

Practice location:
  • Phone: 208-849-2489
  • Fax:
Mailing address:
  • Phone: 661-843-7841
  • Fax: 661-864-7943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP17829
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number17829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: