Healthcare Provider Details

I. General information

NPI: 1629898283
Provider Name (Legal Business Name): DEVRA GATHRIGHT ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 HAVERSHAN ST
SAN ANTONIO TX
78217-3404
US

IV. Provider business mailing address

3402 HAVERSHAN ST
SAN ANTONIO TX
78217-3404
US

V. Phone/Fax

Practice location:
  • Phone: 210-792-7368
  • Fax:
Mailing address:
  • Phone: 210-792-7368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1202751
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1202751
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: