Provider Demographics
NPI:1033774906
Name:GARRETT, KANEITRA NICOLE (LVN)
Entity Type:Individual
Prefix:
First Name:KANEITRA
Middle Name:NICOLE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:SAN AUGUSTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75972-1042
Mailing Address - Country:US
Mailing Address - Phone:936-221-8569
Mailing Address - Fax:
Practice Address - Street 1:924 OLIVER ST
Practice Address - Street 2:
Practice Address - City:SAN AUGUSTINE
Practice Address - State:TX
Practice Address - Zip Code:75972-1042
Practice Address - Country:US
Practice Address - Phone:936-221-8569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330788164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse