Individual
HOLLY THRAILKILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
1405 S 8TH ST, LA PORTE, TX 77571-6207
(832) 262-8358
Mailing address
1405 S 8TH ST, LA PORTE, TX 77571-6207
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
759528
TX
163WN1003X
Nutrition Support Registered Nurse
759528
TX
363LA2200X
Adult Health Nurse Practitioner
759528
TX
363LA2200X
Adult Health Nurse Practitioner
Primary
759628
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
08/18/2016
Last updated
07/02/2019
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