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General NPI Number Information
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NPI Number | 1366209272
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Entity Type | Individual
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Provider Name | MRS. DAWN RAE LIVINGSTON
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Gender | Female
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Dates
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Enumeration Date | 03/06/2024
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 523 S FANNIN AVE
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City | TYLER
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State | TX
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Zip | 75702-8204
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Country | US
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Telephone | 903-535-9041
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Fax | 903-630-2039
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Provider Business Mailing Address
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Address Line | 658 PYEATT DR
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City | GLADEWATER
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State | TX
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Zip | 75647-7842
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Country | US
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Telephone | 903-239-3239
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1154514
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License Number State | TX
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