Debra Sue Mahoney, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP109268 Issued in TX

Practice address

1600 Broadway Ave
Gladewater, TX 75647-5040

Phone

(903) 315-5630

Fax

(903) 845-6212

NPI assigned

Jan 22, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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.

• Christus Trinity Clinic Texas

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225

  TX

  Medicare reassignment NPD
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD
• Diagnostic Clinic of Longview PA

  • Internal Medicine Physician
  • Longview, TX
  • NPI 1386638468
  NPD (past)
• East Texas Border Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Texarkana, TX
  • NPI 1598366718
  NPD (past)
• Tyler Internal Medicine Associates, P.a.

  • Internal Medicine Physician
  • Tyler, TX
  • NPI 1770695850
  NPD (past)

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/ADCFBA
• FHIR API: https://api.platform.athenahealth.com/23550/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1200960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466121600000",
    "number": "1265619241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4207",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756064207",
            "telephone_number": "903-315-4105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 BROADWAY AVE",
            "city": "GLADEWATER",
            "state": "TX",
            "postal_code": "756475040",
            "telephone_number": "903-315-5630",
            "fax_number": "903-845-6212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHONEY",
        "first_name": "DEBRA",
        "middle_name": "SUE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-22",
        "last_updated": "2016-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP109268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Legend Healthcare Gladewater, LP
• Longview Walk-in Clinic
• Aubrey Kay Lucas, RN
• Raymonda Kay Lucas, LMT
• Geraci Mack, LBSW, MHA, CHAPLAIN
• Thomas Vincent Mahoney, CRNA
• Lacy N Martinho
• Erin Sharpton McElhaney
• Shera Elice McNeely, LMT
• Michelle'S Salon of Cuts and Styles/ Non-Surgical Hair Replacement Center

• All providers in Gladewater, TX
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.