Individual
LEIGHTON GARRETT PATRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 PHIL AVE, WORTHAM, TX 76693-4612
(254) 203-2495
Mailing address
1501 SHILOH RD S, MEXIA, TX 76667-3912
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
1010747
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29358294
DRIVERS LICENSE
TX
Enumeration date
06/08/2021
Last updated
06/08/2021
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