Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 13247 | TX |
NPI | 1003367731 |
---|---|
Provider Name | Dr. Tamikia Latray Prunty |
First Address | Carrollton, TX 75007-5435 |
Second Address | Carrollton, TX 75007-2468 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2016 |
Last Update Date | 24/12/2020 |