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General NPI Number Information
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NPI Number | 1386085744
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Entity Type | Organization
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Legal Business Name | KKS SERVICES
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 412 N 1ST ST
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City | LUFKIN
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State | TX
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Zip | 75901-3006
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Country | US
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Telephone | 936-634-1166
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Fax | 936-634-1562
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Provider Business Mailing Address
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Address Line | 412 N 1ST ST
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City | LUFKIN
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State | TX
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Zip | 75901-3006
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Country | US
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Telephone | 936-634-1166
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Fax | 936-634-1562
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KATHLYN JACKSON
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Credential | RN, MSN
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Telephone | 936-634-1166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 010019
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License Number State | TX
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