Provider Demographics
NPI:1730755083
Name:DEBRA JO UNCAPHER
Entity type:Organization
Organization Name:DEBRA JO UNCAPHER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:UNCAPHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-833-0033
Mailing Address - Street 1:1409 W MARKET ST STE 108
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6005
Mailing Address - Country:US
Mailing Address - Phone:423-833-0033
Mailing Address - Fax:423-833-0031
Practice Address - Street 1:1409 W MARKET ST STE 108
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6005
Practice Address - Country:US
Practice Address - Phone:423-833-0033
Practice Address - Fax:423-833-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty