Individual
KA'LERIA CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
442 CARROLL AVE, WAKE VILLAGE, TX 75501-5733
(870) 397-2808
Mailing address
442 CARROLL AVE, WAKE VILLAGE, TX 75501-5733
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
125333
AR
Other
Enumeration date
10/27/2020
Last updated
10/27/2020
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