Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 658488 | TX |
NPI | 1104889443 |
---|---|
Provider Name | Nicole Kern |
First Address | Dallas, TX 75251-1934 |
Second Address | Richardson, TX 75082-3542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 08/07/2007 |