Basic Information
| Provider Information | |||||||||
| NPI: | 1194199604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AUTRY | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 913 WASHBURN DR | ||||||||
| Address2: | |||||||||
| City: | LEANDER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786418360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124663320 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6222 N LAMAR BLVD | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787524004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124724357 | ||||||||
| FaxNumber: | 5127031390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2015 | ||||||||
| LastUpdateDate: | 11/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 137953 | TX | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.