Provider Demographics
NPI:1851046007
Name:PUCKETT, KAYE (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KAYE
Middle Name:
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6156
Mailing Address - Country:US
Mailing Address - Phone:940-683-2338
Mailing Address - Fax:
Practice Address - Street 1:2202 US HIGHWAY 380 STE 112
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2177
Practice Address - Country:US
Practice Address - Phone:940-683-2338
Practice Address - Fax:940-683-2394
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1851046007Medicaid
TX8RH312OtherBCBS OF TEXAS