Individual
JACKIE MAYFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
401 JET DR, LONGVIEW, TX 75603-9498
(903) 932-1564
Mailing address
401 JET DR, LONGVIEW, TX 75603-9498
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
16500
TX
Other
Enumeration date
04/02/2019
Last updated
04/02/2019
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