Individual
MRS. CAROLYN FUQUAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
120 N WALNUT ST, JEFFERSON, TX 75657-1934
(903) 665-6131
(903) 665-7244
Mailing address
PO BOX 901, JEFFERSON, TX 75657-0901
(903) 665-6131
(903) 665-7244
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
637660
TX
163WA2000X
Administrator Registered Nurse
Primary
637660
TX
163WC0400X
Case Management Registered Nurse
637660
TX
Other
Enumeration date
02/27/2018
Last updated
02/27/2018
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