Individual
CONCHETTA TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
305 IRONOSA ST, SAN AUGUSTINE, TX 75972-1721
(936) 201-9869
Mailing address
305 IRONOSA ST, SAN AUGUSTINE, TX 75972-1721
(936) 201-9869
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
349515
TX
Other
Enumeration date
08/02/2019
Last updated
08/02/2019
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