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General NPI Number Information
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NPI Number | 1508153438
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Entity Type | Individual
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Provider Name | DEITRA FALGOUT LEBOUEF APRN-BC
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Gender | Female
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 11/09/2024
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Provider Practice Location Address
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Address Line | 5924 W PARKER RD STE 100
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City | PLANO
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State | TX
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Zip | 75093-6417
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Country | US
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Telephone | 972-697-5954
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Fax | 469-259-2854
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Provider Business Mailing Address
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Address Line | 6309 N PRESIDENT GEORGE BUSH HWY APT 9202
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City | GARLAND
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State | TX
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Zip | 75044-5542
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Country | US
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Telephone | 972-697-5954
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Fax | 469-259-2854
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 664217
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | AP120783
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP120783
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License Number State | TX
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