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1609624097
KENNA PROVOST FAREK
LUBBOCK, TX
NPI
1609624097
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
(Licence: TX BP10090108)
Enumeration Date
2024-05-09
Last Update Date
2024-05-09
Business Address
KENNA PROVOST FAREK MD
3601 4TH ST # MS 9901
LUBBOCK, TX 79430-0002
Phone number: 806-743-2757
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Mailing Address
KENNA PROVOST FAREK MD
3601 4TH ST # MS 9901
LUBBOCK, TX 79430-0002
Phone number:
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