Individual
DUSTIN HEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9846 HWY 31 E, TYLER, TX 75705-2329
(903) 592-8001
Mailing address
9846 HWY 31 E, TYLER, TX 75705-2329
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
336168
TX
Other
Enumeration date
09/17/2020
Last updated
09/17/2020
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