Healthcare Provider Details

I. General information

NPI: 1659922086
Provider Name (Legal Business Name): DEBRA HULSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 VALHALLA DR
WHARTON TX
77488-9218
US

IV. Provider business mailing address

305 SANDY CORNER RD
EL CAMPO TX
77437-9535
US

V. Phone/Fax

Practice location:
  • Phone: 979-532-2000
  • Fax:
Mailing address:
  • Phone: 979-543-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP142288
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: