Provider Demographics
NPI:1366874505
Name:VANOVER, DEBORAH DARLENE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:DARLENE
Last Name:VANOVER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:DARLENE
Other - Last Name:WESTFALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-2609
Practice Address - Street 1:2246 NALL ST
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-4208
Practice Address - Country:US
Practice Address - Phone:409-722-4400
Practice Address - Fax:409-722-4409
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX597450363LF0000X
TXAP123889363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX331471808Medicaid
TXP02601531OtherMCRR
TX1K1915OtherMEDICARE