Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 759528 | TX |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 759628 | TX |
NPI | 1003361098 |
---|---|
Provider Name | Holly Thrailkill |
First Address | La Porte, TX 77571-6207 |
Second Address | La Porte, TX 77571-6207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2016 |
Last Update Date | 02/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NONE | NONE (01) |