Individual
MS. KENTOYA VENGA WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4504 EDINBURGH DR, TYLER, TX 75703-2303
(903) 539-7754
Mailing address
4504 EDINBURGH DR, TYLER, TX 75703-2303
(903) 539-7754
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
03/13/2018
Last updated
03/13/2018
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