Basic Information
| Provider Information | |||||||||
| NPI: | 1376515080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATKINSON | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CADA | ||||||||
| OtherFirstName: | DEBRA | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3430 W EDGEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651096961 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1930 N BUSINESS ROUTE 5 | ||||||||
| Address2: | UNIT 1A | ||||||||
| City: | CAMDENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650202659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733465624 | ||||||||
| FaxNumber: | 5733461957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 06/14/2019 | ||||||||
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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 | 207Q00000X | 2000162958 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 438746 | 01 | HEALTHLINK | OTHER | G25024 | 01 | MERCY | OTHER | 440546366 | 01 | UNITED HEALTHCARE | OTHER | MA4964061 | 01 | MO | MEDICARE PTAN | OTHER | 3156281 | 01 | CIGNA | OTHER | 937875 | 01 | FIRST HEALTH | OTHER | 205061104 | 05 | MO | MEDICAID | 080165723 | 01 | RR MEDICARE | OTHER | 130110 | 01 | BLUE CROSS BLUE SHIELD | OTHER |