Active NPI
Bettie Degracia, PA-C
- Physician Assistant
- Waco, TX
National Provider Identifier
1710514302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA13381
- Practice address
- 405 Londonderry Dr Ste 311
Waco, TX 76712-7922 - Phone
- (254) 537-6550
- NPI assigned
- Mar 24, 2020
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA13381 | TX | Primary |
Addresses
Primary practice location
405 Londonderry Dr Ste 311
Waco, TX 76712-7922
Mailing address
5704 Tumbled Stone Dr
Killeen, TX 76542-5372
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585008000000",
"number": "1710514302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5704 TUMBLED STONE DR",
"city": "KILLEEN",
"state": "TX",
"postal_code": "765425372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 LONDONDERRY DR STE 311",
"city": "WACO",
"state": "TX",
"postal_code": "767127922",
"telephone_number": "254-537-6550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEGRACIA",
"first_name": "BETTIE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-24",
"last_updated": "2020-03-24",
"certification_date": "2020-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA13381",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; 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.