Individual
MISS JACIE B WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
702 S 10TH AVE, TEAGUE, TX 75860-2308
(254) 747-0010
Mailing address
4030 HIGHWAY 6 S STE 150, COLLEGE STATION, TX 77845-1808
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
341805
TX
Other
Enumeration date
07/11/2018
Last updated
07/11/2018
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