Active NPI
Debra Kay Waters, MLT
- Medical Laboratory Technician
- Fort Washakie, WY
National Provider Identifier
1285950170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Laboratory Technician
- License
- 21259
- Practice address
- Black Coal Rd. BLDG. 29
Ft. Washakie, WY 82514 - Phone
- (307) 332-7672
- NPI assigned
- Apr 16, 2010
- Last updated
- Apr 16, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Laboratory Technician | 246RM2200X | 21259 | TN | Primary |
Addresses
Primary practice location
Black Coal Rd. BLDG. 29
Ft. Washakie, WY 82514
Mailing address
29 Black Coal Rd.
Ft. Washakie, WY 82514
Phone (307) 332-7672
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04121413 | Other | TN | ASCP |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21259 | TN | MD | Medical Laboratory Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271376000000",
"number": "1285950170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 BLACK COAL RD.",
"city": "FT. WASHAKIE",
"state": "WY",
"postal_code": "82514",
"telephone_number": "307-332-7672"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BLACK COAL RD. BLDG. 29",
"city": "FT. WASHAKIE",
"state": "WY",
"postal_code": "82514",
"telephone_number": "307-332-7672"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERS",
"first_name": "DEBRA",
"middle_name": "KAY",
"credential": "MLT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-04-16",
"last_updated": "2010-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "246RM2200X",
"taxonomy_group": "",
"desc": "Technician, Pathology, Medical Laboratory",
"state": "TN",
"license": "21259",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASCP",
"identifier": "04121413",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Washakie, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.