Individual
MR. TREVON ROSHAD DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP-BC
Contact information
Practice address
1600 11TH ST, WICHITA FALLS, TX 76301-4300
(940) 764-8400
Mailing address
1201 SUNNYSIDE LN, WICHITA FALLS, TX 76301-8172
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP135794
TX
Other
Enumeration date
11/09/2017
Last updated
11/09/2017
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