Individual
KAITLYN MARIE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
621 LONDONDERRY LN # LB, DENTON, TX 76205-7792
(817) 915-3230
Mailing address
13604 GRANITE PARK RD, PONDER, TX 76259-1037
(817) 915-3230
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
1027538
TX
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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