Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP136267 | TX |
NPI | 1003314154 |
---|---|
Provider Name | Precious Cunningham |
First Address | Richardson, TX 75082-2917 |
Second Address | Richardson, TX 75082-2917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2018 |
Last Update Date | 16/06/2020 |