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General NPI Number Information
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NPI Number | 1316551849
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Entity Type | Individual
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Provider Name | DESTINY PAIGE DOGGETT
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Gender | Female
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 2956 COUNTY ROAD 4293
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City | TENAHA
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State | TX
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Zip | 75974-2529
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Country | US
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Telephone | 936-488-9549
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Fax |
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Provider Business Mailing Address
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Address Line | 2956 COUNTY ROAD 4293
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City | TENAHA
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State | TX
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Zip | 75974-2529
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Country | US
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Telephone | 936-488-9549
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 352637
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License Number State | TX
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