Individual
KAY ALLISON WAGSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
3330 FANNIN ST, BEAUMONT, TX 77701-3801
(409) 832-3304
Mailing address
3330 FANNIN ST, BEAUMONT, TX 77701-3801
(409) 832-3304
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
141612
TX
164X00000X
Licensed Vocational Nurse
Primary
141613
TX
Other
Enumeration date
02/26/2018
Last updated
02/26/2018
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