Individual
KYLICIA GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1411 OXBOW DR, CEDAR HILL, TX 75104-4007
(469) 478-9195
Mailing address
1411 OXBOW DR, CEDAR HILL, TX 75104-4007
(469) 478-9195
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000000
N/A
—
Enumeration date
09/16/2019
Last updated
09/16/2019
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