Individual
KIMMERLEY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5722 HIGHWAY 6, HITCHCOCK, TX 77563-2306
(832) 469-1082
Mailing address
5722 HIGHWAY 6, HITCHCOCK, TX 77563-2306
(832) 469-1082
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
348779
TX
Other
Enumeration date
06/11/2019
Last updated
06/11/2019
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