Individual
MR. KENDALL DEREK WASHBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1515 NE LAWRIE TATUM RD, BUILDING 414, LAWTON, OK 73507-3002
(580) 354-5562
(580) 354-5563
Mailing address
1515 NE LAWRIE TATUM RD, BUILDING 414, LAWTON, OK 73507-3002
(580) 354-5562
(580) 354-5563
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
R83207
OK
Other
Enumeration date
01/11/2011
Last updated
01/11/2011
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