Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 678538 | TX |
NPI | 1003110453 |
---|---|
Provider Name | Miss Kristy L Fuhrken |
First Address | Corpus Christi, TX 78410-5137 |
Second Address | Robstown, TX 78380-3134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2010 |
Last Update Date | 28/12/2010 |