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General NPI Number Information
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NPI Number | 1235676529
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Entity Type | Organization
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Legal Business Name | J K MANGREM
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 7 HOSPITAL DR
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City | ABILENE
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State | TX
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Zip | 79606-5269
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Country | US
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Telephone | 325-437-4730
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Fax |
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Provider Business Mailing Address
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Address Line | 7 HOSPITAL DR.
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City | ABILENE
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State | TX
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Zip | 79606
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Country | US
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Telephone | 325-437-4730
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Fax |
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | DR. KELSI MANGREM
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Credential | AU.D.
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Telephone | 325-437-4730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 80588
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License Number State | TX
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