Basic Information
| Provider Information | |||||||||
| NPI: | 1114918646 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOERTH | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 758 N DOGWOOD CT | ||||||||
| Address2: | |||||||||
| City: | NIXA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657147216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033697978 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 655369238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4175336100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 03/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 151783 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | P00398983 | 01 | KS | RR MEDICARE GROUP CQ2302 | OTHER | 100381010B | 05 | KS | MEDICAID | 145411 | 01 | KS | BCBS OF KS | OTHER |