Organization
STONEWALL FELLOWSHIP CHURCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DESMOND TOLBERT (OWNER)
(936) 219-4611
Entity
Organization
Contact information
Practice address
1303 SOUTH UNIVERSITY DR, NACOGDOCHES, TX 75961
(936) 219-4611
Mailing address
1303 SOUTH UNIVERSITY DR, NACOGDOCHES, TX 75961
(936) 219-4611
Taxonomy
Speciality
Code
Description
License number
State
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/16/2026
Last updated
01/16/2026
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