Healthcare Provider Details

I. General information

NPI: 1770993065
Provider Name (Legal Business Name): KATY KEMEZE NGUEFACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N FRANKFORD AVE
LUBBOCK TX
79416
US

IV. Provider business mailing address

2215 NASHVILLE AVE
LUBBOCK TX
79410-1105
US

V. Phone/Fax

Practice location:
  • Phone: 806-725-5840
  • Fax: 806-723-6156
Mailing address:
  • Phone: 806-725-5844
  • Fax: 806-723-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR8765
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: