Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP142168 | TX |
NPI | 1083266183 |
---|---|
Provider Name | Dusty Rhoades |
First Address | Sherman, TX 75092-3480 |
Second Address | Sherman, TX 75092-3480 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2019 |
Last Update Date | 10/07/2019 |