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General NPI Number Information
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NPI Number | 1962090928
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Entity Type | Individual
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Provider Name | TINA LANKFORD
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Gender | Female
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 502 N HAMPTON RD STE C
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City | DESOTO
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State | TX
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Zip | 75115-4963
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Country | US
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Telephone | 469-297-4256
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Fax |
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Provider Business Mailing Address
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Address Line | 613 SPICE ST
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City | DESOTO
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State | TX
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Zip | 75115-1482
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Country | US
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Telephone | 972-880-6172
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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 | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 1635676
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License Number State | TX
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