Provider Demographics
NPI:1053637165
Name:ROY, WILDA D
Entity Type:Individual
Prefix:
First Name:WILDA
Middle Name:D
Last Name:ROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WILDA
Other - Middle Name:D
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HCS, TXHML
Mailing Address - Street 1:5044 LAKE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4015
Mailing Address - Country:US
Mailing Address - Phone:469-556-9933
Mailing Address - Fax:972-625-6881
Practice Address - Street 1:5044 LAKE VISTA DR
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-4015
Practice Address - Country:US
Practice Address - Phone:469-556-9933
Practice Address - Fax:972-625-6881
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator