Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 1015736 | TX |
NPI | 1043884885 |
---|---|
Provider Name | Rebecca Couch |
First Address | Alba, TX 75410-8065 |
Second Address | Winnsboro, TX 75494-2604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2021 |
Last Update Date | 17/05/2021 |