| Doctor Name: | DEBORAH WYATT GADDIS |
| NPI Number: | 1619246873 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 16232 |
| Business Practice Address: | 24 Mountain View Dr Suite A Kimball, TN - 373475477 |
| Business Phone Number: | 4239429171 |
| Business Fax Number: | 4239429128 |
| Mailing Address: | 24 Mountain View Dr, Suite A KIMBALL |
| State: | TN |
| Postal Code: | 373475477 |
| Phone Number: | 4239429171 |
| Fax Number: | 4239429128 |
| NPI Enumeration Date: | 12/16/2011 |
| NPI Last Update Date: | 05/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 16232 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |