Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Mar 27, 2023
License(s)
1112143 (TX)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 112 SPARKS DR | Forest City, NC 28043-9021 | 704-675-7279 |
| LOCATION | 4616 NE STALLINGS DR | Nacogdoches, TX 75965-1608 | 936-569-5600 |
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