Individual
KELLY LEIGH SIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16721 N ELM ST, FRANKSTON, TX 75763-2247
(903) 681-2121
Mailing address
16721 N ELM ST, FRANKSTON, TX 75763-2247
(903) 681-2121
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
177982
TX
Other
Enumeration date
02/19/2018
Last updated
02/19/2018
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