Provider Demographics
NPI:1477040368
Name:MANN, YKETTA (BSN, RN)
Entity Type:Individual
Prefix:
First Name:YKETTA
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6023 STONEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-4422
Mailing Address - Country:US
Mailing Address - Phone:806-438-4262
Mailing Address - Fax:512-996-9905
Practice Address - Street 1:6023 STONEHAVEN DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-4422
Practice Address - Country:US
Practice Address - Phone:806-438-4262
Practice Address - Fax:512-996-9905
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX730845163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse