Healthcare Provider Details

I. General information

NPI: 1124333299
Provider Name (Legal Business Name): DEBORAH ANN EDINGTON APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S CHAPPELL HILL ST STE 106
BRENHAM TX
77833-3942
US

IV. Provider business mailing address

100 S CHAPPELL HILL ST STE 106
BRENHAM TX
77833-3942
US

V. Phone/Fax

Practice location:
  • Phone: 979-836-6771
  • Fax: 979-836-6794
Mailing address:
  • Phone: 979-836-6771
  • Fax: 979-836-6794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number800018
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number67755
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: