Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 843209 | TX |
NPI | 1003421744 |
---|---|
Provider Name | Kamia Rochelle Scroggins Fasheun |
First Address | Georgetown, TX 78628-5236 |
Second Address | Georgetown, TX 78628-5236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2020 |
Last Update Date | 10/09/2020 |