Individual
LACRESHA DANYELL YOUNGBLOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
755 S BECKHAM AVE, TYLER, TX 75701-1903
(903) 534-4684
Mailing address
2801 BILL OWENS PKWY APT 203, LONGVIEW, TX 75605-2169
(903) 490-6430
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L043813
AR
Other
Enumeration date
02/19/2018
Last updated
02/19/2018
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