MEDICARE: DEVRA GATHRIGHT ACNPC-AG

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	363LC0200X	Critical Care Medicine Nurse Practitioner	1202751	TX
2	363LA2100X	Acute Care Nurse Practitioner	1202751	TX

General Provider Information

NPI Number	:	1629898283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVRA GATHRIGHT ACNPC-AG

Provider Business Mailing Address
First Line	:	3402 HAVERSHAN ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-3404
Country	:	US
Telephone Number	:	210-792-7368
Fax Number	:

Provider Business Practice Location Address
First Line	:	3402 HAVERSHAN ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-3404
Country	:	US
Telephone Number	:	210-792-7368
Fax Number	:

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

Provider Enumeration Date	:	10/16/2024
Last Update Date	:	08/11/2025

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