Healthcare Provider Details

I. General information

NPI: 1285148585
Provider Name (Legal Business Name): DEANNA ROBIN PADGETT PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 COLLEGE DR
TEXARKANA TX
75501-2788
US

IV. Provider business mailing address

912 ROLLING RIDGE DR
TEXARKANA AR
71854-9030
US

V. Phone/Fax

Practice location:
  • Phone: 903-831-7585
  • Fax:
Mailing address:
  • Phone: 903-701-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA005380
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP135964
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: