SHANE DAVID STATHAM

WICHITA FALLS, TX
NPI1902422603
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: TX  1017571)
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2020-06-18
Last Update Date2024-10-23
Business Address
SHANE DAVID STATHAM
5800 KELL BLVD STE 500
WICHITA FALLS, TX 76310-1618
Phone number: 940-260-8976
Mailing Address
SHANE DAVID STATHAM
5800 KELL BLVD STE 500
WICHITA FALLS, TX 76310-1618
Phone number: 940-260-8976