Individual provider Active NPI

Deborah Garganera Ledesma, FNP-C

  • Family Nurse Practitioner
  • Jacksonville, TX
National Provider Identifier
1114625670
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1103164 Issued in TX
Practice address
510 E Commerce St
Jacksonville, TX 75766-4910
Phone
(903) 535-9041
NPI assigned
Feb 22, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1103164 TX Primary

Addresses

Primary practice location

510 E Commerce St
Jacksonville, TX 75766-4910

Mailing address

523 S Fannin Ave
Tyler, TX 75702-8204
Phone (903) 535-9041

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230322002746 TX Practitioner - Nurse Practitioner 7012381635 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tyler Family Circle of CareGroup PAC ID 4587812888, 28 clinicians
Whitehouse Premier Health and Wellness, LLCGroup PAC ID 4880131069, 2 clinicians

Practice addresses (Care Compare)

13172 State Hwy 64 E
Tyler, TX 75707-5340
Phone (903) 606-2212

602 State Hwy 110 N
Whitehouse, TX 75791-3053
Phone (903) 521-3650

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1103164TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Whitehouse Premier Health and Wellness LLC Family CurrentSince Aug 1, 2025 Accepting new patients
Tyler Family Circle of Care CurrentSince Jan 19, 2025 Accepting new patients

Locations

523 S Fannin Ave
Tyler, TX 75702

602 State Highway 110 N
Whitehouse, TX 75791
Phone (903) 521-3650

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1677024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1114625670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 S FANNIN AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028204",
            "telephone_number": "903-535-9041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 E COMMERCE ST",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757664910",
            "telephone_number": "903-535-9041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEDESMA",
        "first_name": "DEBORAH",
        "middle_name": "GARGANERA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-22",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1103164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, TX

Sources for this page

Verify at the official NPI Registry.