Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP126102 | TX |
NPI | 1013325638 |
---|---|
Provider Name | Rendall Northcutt |
First Address | Dallas, TX 75373-1912 |
Second Address | Tyler, TX 75708-3154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2014 |
Last Update Date | 06/11/2020 |