Individual
KELLY GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
700 N WHITE OAK RD LOT B5, WHITE OAK, TX 75693-2565
(903) 240-1363
Mailing address
700 N WHITE OAK RD LOT B5, WHITE OAK, TX 75693-2565
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
329538
TX
Other
Enumeration date
04/09/2019
Last updated
04/09/2019
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