=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073627428
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA JONES MYERS RN, BSN, CNOR, RNFA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8001 YOUREE DR SUITE 550
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71115-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-797-5543
-----------------------------------------------------
Fax | 318-797-7608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2524 SPRUCE DR
-----------------------------------------------------
City | BOSSIER CITY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71111-5133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-294-1804
-----------------------------------------------------
Fax | 318-797-7608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WN0800X
-----------------------------------------------------
Taxonomy Name | Neuroscience Registered Nurse
-----------------------------------------------------
License Number | RN097814
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------