Healthcare Provider Details

I. General information

NPI: 1578965166
Provider Name (Legal Business Name): DEBORA R. HALL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 N CORNERSTONE DR
SHERMAN TX
75092-2551
US

IV. Provider business mailing address

PO BOX 844693 ATTN: IPM CREDENTIALING
DALLAS TX
75284-4693
US

V. Phone/Fax

Practice location:
  • Phone: 903-416-3024
  • Fax: 903-416-3001
Mailing address:
  • Phone: 903-416-1726
  • Fax: 903-416-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAP104013
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: