MEDICARE: ZACKIE KYLE MONROE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WX0106X	Occupational Health Registered Nurse	1116661	TX

General Provider Information

NPI Number	:	1790611333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACKIE KYLE MONROE RN

Provider Business Mailing Address
First Line	:	10001 JACK FINNEY BLVD
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-3119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10001 JACK FINNEY BLVD
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-3119
Country	:	US
Telephone Number	:	903-457-4330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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