Provider Demographics
NPI:1730194887
Name:BOETTNER, DEBBIE ARNOLD (PA-C / BS)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:ARNOLD
Last Name:BOETTNER
Suffix:
Gender:F
Credentials:PA-C / BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1890
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-1390
Mailing Address - Country:US
Mailing Address - Phone:830-672-6511
Mailing Address - Fax:830-672-6430
Practice Address - Street 1:902 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621
Practice Address - Country:US
Practice Address - Phone:512-229-3334
Practice Address - Fax:512-229-3335
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX970025641Medicaid
TX970025640Medicaid
TX970025640Medicaid
TX8B3833Medicare PIN