Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1356997332 |
---|---|
Provider Name | Taylor Nicole Hickson |
First Address | Longview, TX 75605-6061 |
Second Address | San Antonio, TX 78229-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2019 |
Last Update Date | 14/08/2019 |