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General NPI Number Information
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NPI Number | 1891511432
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Entity Type | Individual
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Provider Name | KYSEN DANE SUE CPT
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Gender | Male
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 4617 50TH ST STE 5
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City | LUBBOCK
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State | TX
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Zip | 79414-3507
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Country | US
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Telephone | 806-599-6299
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Fax |
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Provider Business Mailing Address
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Address Line | 5815 82ND ST, SUITE 145 / PMB 108
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City | LUBBOCK
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State | TX
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Zip | 79424
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Country | US
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Telephone | 806-599-6299
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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 | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | NPCN-17321-11162
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License Number State | TX
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