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General NPI Number Information
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NPI Number | 1063819142
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Entity Type | Organization
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Legal Business Name | LOWT OF TEXOMA
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Dates
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Enumeration Date | 12/04/2014
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Last Update Date | 12/04/2014
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Provider Practice Location Address
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Address Line | 4001 CEDAR ELM LN SUITE B
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City | WICHITA FALLS
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State | TX
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Zip | 76308-3031
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Country | US
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Telephone | 940-386-9334
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Fax | 940-386-9733
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Provider Business Mailing Address
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Address Line | 4001 CEDAR ELM LN SUITE B
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City | WICHITA FALLS
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State | TX
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Zip | 76308-3031
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Country | US
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Telephone | 940-386-9334
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Fax | 940-386-9733
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Authorized Official
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Title or Position | OWNER
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Name | ANTOINETTE RENE NUNNELEY
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Credential | APRN
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Telephone | 940-386-9334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AP110354
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License Number State | TX
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