Individual
KODY ALLEN WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
5412 24TH ST, LUBBOCK, TX 79407-2130
(432) 935-1359
Mailing address
5412 24TH ST, LUBBOCK, TX 79407-2130
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
841112
TX
Other
Enumeration date
02/20/2018
Last updated
02/20/2018
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