Individual
KIANTE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2136 FM 757, TYLER, TX 75705-4520
(903) 590-9511
Mailing address
11205 TIMBER CREEK DR, TYLER, TX 75707-5353
(903) 363-7032
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
28007345
TX
Other
Enumeration date
01/23/2017
Last updated
01/23/2017
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