Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 761618 | TX |
NPI | 1003150186 |
---|---|
Provider Name | Kevin Cole |
First Address | Lubbock, TX 79415-3300 |
Second Address | Lubbock, TX 79415-3300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 15/11/2012 |