Individual
MR. CODY RYAN JUSTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1600 11TH ST, WICHITA FALLS, TX 76301-4300
(940) 764-7000
Mailing address
3017 WEAVE CT, GRANBURY, TX 76049-1280
(817) 454-7151
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
893913
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
1066724
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780347641
—
TX
Enumeration date
10/18/2021
Last updated
01/19/2022
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