Provider Demographics
NPI:1538245147
Name:LEEPER, DEBORAH L (CRNA)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:L
Last Name:LEEPER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-0039
Mailing Address - Country:US
Mailing Address - Phone:800-228-0249
Mailing Address - Fax:252-222-3602
Practice Address - Street 1:907 RIVERGATE PKWY
Practice Address - Street 2:SUITE C2020
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2324
Practice Address - Country:US
Practice Address - Phone:800-228-0249
Practice Address - Fax:252-222-3602
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN32198207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3002445OtherTNCARE-BC SELECT
TN3002445OtherBLUE CROSS
TN3603233Medicare ID - Type Unspecified