Provider Demographics
NPI:1144284761
Name:HUNTER, DEBORAH KAY (PA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:HUNTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:KAY
Other - Last Name:HOLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2680 LEONARD ST NE STE 3
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6902
Mailing Address - Country:US
Mailing Address - Phone:616-317-7246
Mailing Address - Fax:616-920-6540
Practice Address - Street 1:2680 LEONARD ST NE STE 3
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6902
Practice Address - Country:US
Practice Address - Phone:616-317-7246
Practice Address - Fax:616-920-6540
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001855363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
970003152OtherRAILROAD MEDICARE
MI23041OtherHEALTH PLAN OF MICHIGAN
S08339Medicare UPIN
970003152OtherRAILROAD MEDICARE