Provider Demographics
NPI:1548530892
Name:BIRCH, DEBRA LYNN (NP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:BIRCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL PARK
Mailing Address - Street 2:SUITE 702
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-243-8409
Mailing Address - Fax:304-243-8804
Practice Address - Street 1:1 MEDICAL PARK
Practice Address - Street 2:SUITE 702
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-8409
Practice Address - Fax:304-243-8804
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV55609363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0060587Medicaid