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General NPI Number Information
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NPI Number | 1811751985
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Entity Type | Individual
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Provider Name | KATHY WILCOX
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Gender | Female
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Dates
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Enumeration Date | 02/09/2024
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Last Update Date | 02/10/2024
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Provider Practice Location Address
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Address Line | 217 N MOUND ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-5031
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Country | US
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Telephone | 936-462-0991
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Fax |
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Provider Business Mailing Address
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Address Line | 226 W GREENWOOD ST
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City | GARRISON
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State | TX
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Zip | 75946-2427
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Country | US
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Telephone | 936-462-0991
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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 | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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