MEDICARE: DEBORAH KAY GOSSETT APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	188588	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295954808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH KAY GOSSETT APN

Provider Business Mailing Address
First Line	:	1300 PETTWAY CIR
Second Line	:
City	:	GREENWOOD
State	:	AR
Zip	:	72936-3729
Country	:	US
Telephone Number	:	479-996-7269
Fax Number	:

Provider Business Practice Location Address
First Line	:	3112 S 70TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5068
Country	:	US
Telephone Number	:	479-452-8600
Fax Number	:	479-452-7844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	02/20/2013

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