Provider Demographics
NPI:1578013504
Name:MARTI, DEBRA KAY (FNP-C)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:KAY
Last Name:MARTI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:KAY
Other - Last Name:BACON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:8 TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334-2803
Mailing Address - Country:US
Mailing Address - Phone:573-324-2241
Mailing Address - Fax:573-324-9854
Practice Address - Street 1:8 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-2803
Practice Address - Country:US
Practice Address - Phone:573-324-2241
Practice Address - Fax:573-324-9854
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9356255363LF0000X, 363LF0000X
MO2019019298363LF0000X, 208D00000X
NMAPRN57161363LF0000X
NM57161363LF0000X, 363LF0000X, 163WG0000X
FLARNP9356255163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice