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General NPI Number Information
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NPI Number | 1306372917
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Entity Type | Organization
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Legal Business Name | LECELT, INC
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 2133 OFFICE PARK DR STE A
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City | SAN ANGELO
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State | TX
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Zip | 76904-6803
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Country | US
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Telephone | 325-703-6670
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Fax | 325-703-6672
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Provider Business Mailing Address
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Address Line | 3371 KNICKERBOCKER RD # 236
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City | SAN ANGELO
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State | TX
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Zip | 76904-6814
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Country | US
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Telephone | 325-703-6670
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Fax | 325-703-6672
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Authorized Official
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Title or Position | OWNER
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Name | MS. JEAN LYNN HENRIKSON
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Credential | FNP
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Telephone | 325-703-6670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | TX
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