Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 111NN1001X | TX |
NPI | 1003474727 |
---|---|
Provider Name | Jamie S Busby |
First Address | Mckinney, TX 75071-6640 |
Second Address | Mckinney, TX 75071-5400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2019 |
Last Update Date | 29/05/2019 |