Basic Information
| Provider Information | |||||||||
| NPI: | 1932514007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUZMAN | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | CARPENTER | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 S STAPLES | ||||||||
| Address2: | STE 150 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618008155 | ||||||||
| FaxNumber: | 3618822590 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 S STAPLES | ||||||||
| Address2: | STE 150 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618008155 | ||||||||
| FaxNumber: | 3618822590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2014 | ||||||||
| LastUpdateDate: | 08/19/2015 | ||||||||
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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 | 363LF0000X | AP125886 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 354660YMVU | 01 | WELLMED NETWORKS INC | OTHER | 338670801 | 05 | TX | MEDICAID | 354660YLPS | 01 | WELLMED MEDICAL GROUP PA | OTHER |