Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 4301076863 | MI |
Y | 207QA0505X | Family Doctor - Adult Medicine | T0200 | TX |
NPI | 1124061817 |
---|---|
Provider Name | Dr. Kenya Sekoni Etim |
First Address | Jacksonville, TX 75766-2444 |
Second Address | Jacksonville, TX 75766-2444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 23/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I00864 | (02) | MI |