=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548911993
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEBRA HUNTER PA-C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2022
-----------------------------------------------------
Last Update Date | 02/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 MIRKES PKWY
-----------------------------------------------------
City | DESOTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75115-2972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-849-0825
-----------------------------------------------------
Fax | 972-291-6076
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 MIRKES PKWY
-----------------------------------------------------
City | DESOTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75115-2972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-849-0825
-----------------------------------------------------
Fax | 972-281-6076
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN ASSISTANT
-----------------------------------------------------
Name | DEBRA K HUNTER
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 972-849-0825
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------