Healthcare Provider Details

I. General information

NPI: 1184281032
Provider Name (Legal Business Name): MS. LETITIA KUYKENDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 HILTON HEAD DR
MISSOURI CITY TX
77459-3423
US

IV. Provider business mailing address

1855 HILTON HEAD DR
MISSOURI CITY TX
77459-3423
US

V. Phone/Fax

Practice location:
  • Phone: 832-691-7225
  • Fax:
Mailing address:
  • Phone: 832-691-7225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: