Provider Demographics
NPI:1164754008
Name:MOREAU, DEBORAH J (FNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:MOREAU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 STILLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-7343
Mailing Address - Country:US
Mailing Address - Phone:931-575-5286
Mailing Address - Fax:
Practice Address - Street 1:1623 HOSPITAL LOOP RD
Practice Address - Street 2:
Practice Address - City:OWYHEE
Practice Address - State:NV
Practice Address - Zip Code:89832
Practice Address - Country:US
Practice Address - Phone:775-757-2415
Practice Address - Fax:775-757-3027
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014261363L00000X
KY3010321363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100427820Medicaid