Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP133037 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | AP133037 | TX |
NPI | 1053859819 |
---|---|
Provider Name | Traci Doerre |
First Address | Kerrville, TX 78028-5950 |
Second Address | Kerrville, TX 78028-5950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2017 |
Last Update Date | 04/09/2020 |