Individual
INDYIA LACOUNT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1900 MATLOCK RD STE 804, MANSFIELD, TX 76063-4455
(682) 800-3211
(682) 257-3699
Mailing address
PO BOX 382498, DUNCANVILLE, TX 75138-2498
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1002206
TX
Other
Enumeration date
01/26/2022
Last updated
01/08/2025
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