Individual provider Active NPI

Debra Axley, ARNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Pensacola, FL
National Provider Identifier
1184797458
Registry record updated Sep 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
1012172 Issued in FL
Practice address
4400 Bayou Blvd Ste 43
Pensacola, FL 32503-1910
Phone
(850) 477-3015
Fax
(850) 477-3026
NPI assigned
Nov 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1012172 FL Primary

Addresses

Primary practice location

4400 Bayou Blvd Ste 43
Pensacola, FL 32503-1910

Mailing address

4400 Bayou Blvd Ste 43
Pensacola, FL 32503-1910
Phone (850) 477-3015

Other identifiers 2

IdentifierTypeStateIssuer
P00316280OtherRRB PTAN
306445000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379376000000",
    "number": "1184797458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 BAYOU BLVD STE 43",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325031910",
            "telephone_number": "850-477-3015",
            "fax_number": "850-477-3026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 BAYOU BLVD STE 43",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325031910",
            "telephone_number": "850-477-3015",
            "fax_number": "850-477-3026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AXLEY",
        "first_name": "DEBRA",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2013-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "1012172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRB PTAN",
            "identifier": "P00316280",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "306445000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.