Healthcare Provider Details

I. General information

NPI: 1609854967
Provider Name (Legal Business Name): DEBRA ANNE WALKER FREDERICKS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 W BROOKDALE DR
RENO NV
89523-2279
US

IV. Provider business mailing address

PO BOX 33190
RENO NV
89533-3190
US

V. Phone/Fax

Practice location:
  • Phone: 775-747-5050
  • Fax:
Mailing address:
  • Phone: 775-747-5050
  • Fax: 775-747-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10811
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number10811
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPN000640
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPN000640
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: