Debra Ann Gauthier, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP126216 Issued in TX

Practice address

4513 Williams Dr
Georgetown, TX 78633-1302

Phone

(512) 930-3909

Fax

(128) 695-5868

NPI assigned

Oct 8, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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

Specialty

Nurse Practitioner

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountain West Derm - Blackhart PLLCGroup PAC ID 1153609813, 103 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

96.97 of 100Reported as group

Quality

93.94

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Mountain West Derm - Blackhart PLLC

  dba Vitalogy Skincare

  • Dermatology Physician
  • Georgetown, TX
  • NPI 1366018848
  Medicare reassignment Care Compare group NPD
• Mountain West Derm-Blackhart, PLLC

  • Dermatology Physician
  • Tigard, OR
  • NPI 1316656994
  NPD
• Dermatology Associates,P.C.

  • Specialist
  • Tigard, OR
  • NPI 1851442461
  NPD (past)

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

{
    "created_epoch": "1254960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1679808695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4513 WILLIAMS DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786331302",
            "telephone_number": "512-930-3909",
            "fax_number": "512-869-5868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4513 WILLIAMS DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786331302",
            "telephone_number": "512-930-3909",
            "fax_number": "128-695-5868"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 County Road 340A Ste B",
            "address_purpose": "LOCATION",
            "city": "Burnet",
            "state": "TX",
            "postal_code": "786114528",
            "country_code": "US",
            "telephone_number": "512-756-2525",
            "fax_number": "512-756-2533",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1309 Mormon Mill Rd",
            "address_purpose": "LOCATION",
            "city": "Marble Falls",
            "state": "TX",
            "postal_code": "786544602",
            "country_code": "US",
            "telephone_number": "830-798-1144",
            "fax_number": "830-201-4106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAUTHIER",
        "first_name": "DEBRA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-08",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP126216",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "858302",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1817597",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05670766",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hali Garrett, LCSW
• Alyssa Celeste Garza, OD
• Anna P Garza
• Robert Maldonado Garza, MD
• Tony I Gauntt, PA
• Robin Allison Gayer, OTR/ L
• Matthew Gearhart
• Peter Jeffrey Gembol, FNP
• Genesis Birth Centers (Genesis Community Birth Center)
• Saramma George, M.D.

• Family Nurse Practitioner in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.