MEDICARE: MRS. DEBRA JEAN ROSSELL RN MSN CFNP

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	363LF0000X	Family Nurse Practitioner	246212	TX

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
2	NP0164	OTHER	TX	BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538161328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA JEAN ROSSELL RN MSN CFNP

Provider Business Mailing Address
First Line	:	801 W MAIN ST
Second Line	:
City	:	GUN BARRREL CITY
State	:	TX
Zip	:	75156
Country	:	US
Telephone Number	:	903-887-6252
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 W MAIN ST
Second Line	:
City	:	GUN BARREL CITY
State	:	TX
Zip	:	75156-5312
Country	:	US
Telephone Number	:	903-887-6252
Fax Number	:	903-887-3668

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	03/16/2015

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