MEDICARE: BRITTANIE N TULLOUS

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	164X00000X	Licensed Vocational Nurse	336371	TX

General Provider Information

NPI Number	:	1952968208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANIE N TULLOUS

Provider Business Mailing Address
First Line	:	1723 1/2 MCGREGOR AVE
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-5628
Country	:	US
Telephone Number	:	214-425-8528
Fax Number	:

Provider Business Practice Location Address
First Line	:	1723 1/2 MCGREGOR AVE
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-5628
Country	:	US
Telephone Number	:	214-425-8528
Fax Number	:

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

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	05/22/2019

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Directions to “ BRITTANIE N TULLOUS ” Practice Location

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