Provider Demographics
NPI:1134156805
Name:UPTON, DEBORAH ANN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:UPTON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:SUMPTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:501 N OLD WILDERNESS RD
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9490
Practice Address - Country:US
Practice Address - Phone:417-269-2227
Practice Address - Fax:417-269-2235
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019028126363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420076121Medicaid
NH30343601Medicaid
MO420076121Medicaid
NH30343601Medicaid