Healthcare Provider Details

I. General information

NPI: 1497006282
Provider Name (Legal Business Name): MARY GOTCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W PARKER ST
ELKHART TX
75839-7612
US

IV. Provider business mailing address

PO BOX 4550
PALESTINE TX
75802-4550
US

V. Phone/Fax

Practice location:
  • Phone: 903-764-5686
  • Fax:
Mailing address:
  • Phone: 903-731-4555
  • Fax: 903-731-4699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number241946
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: