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General NPI Number Information
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NPI Number | 1558600015
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Entity Type | Individual
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Provider Name | DEBORAH A FOGG NP
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Gender | Female
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 510 E AMENDE DR
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City | ODESSA
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State | WA
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Zip | 99159-7003
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Country | US
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Telephone | 509-982-2614
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Fax | 509-982-2675
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Provider Business Mailing Address
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Address Line | 294 SARGENT RD
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City | ARGILLITE
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State | KY
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Zip | 41121-8424
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Country | US
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Telephone | 985-264-5776
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4025615
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN083436
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License Number State | LA
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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 | AP60749062
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License Number State | WA
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