=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083696215
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA LYNNE DEBRUIN CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2005
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2131 EAST STATE STREET
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45701-2857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-589-3100
-----------------------------------------------------
Fax | 740-589-3127
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 90 JACKSON PIKE
-----------------------------------------------------
City | GALLIPOLIS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45631-1560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-446-5937
-----------------------------------------------------
Fax | 740-589-3123
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.07926
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------