Provider Demographics
NPI:1710906268
Name:DEVELIN, DEBRA MIMS (CRNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:MIMS
Last Name:DEVELIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:MS
Mailing Address - Zip Code:39153-6016
Mailing Address - Country:US
Mailing Address - Phone:601-374-8145
Mailing Address - Fax:601-374-8153
Practice Address - Street 1:234 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:MS
Practice Address - Zip Code:39153-6016
Practice Address - Country:US
Practice Address - Phone:601-374-8145
Practice Address - Fax:601-374-8153
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR633283363LF0000X
AL1-093189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03235798Medicaid
MS03235798Medicaid