Individual
MRS. TABATHA DAWN HOLLOWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2814 LOMA LINDA LN, WICHITA FALLS, TX 76308-4716
(940) 782-1393
Mailing address
2814 LOMA LINDA LN, WICHITA FALLS, TX 76308-4716
(940) 782-1393
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
20961897
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
519030413
—
TX
Enumeration date
09/25/2020
Last updated
09/25/2020
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