Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP127035 | TX |
NPI | 1033585799 |
---|---|
Provider Name | Mr. Rollie Rockett |
First Address | San Antonio, TX 78204-1650 |
Second Address | San Antonio, TX 78204-1650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2015 |
Last Update Date | 18/08/2015 |