Provider Demographics
NPI:1275374340
Name:JUST A GIRL FROM THE BAYOU
Entity type:Organization
Organization Name:JUST A GIRL FROM THE BAYOU
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEESHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NIX
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, MHA
Authorized Official - Phone:512-705-0370
Mailing Address - Street 1:513 HICKORY RUN DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3993
Mailing Address - Country:US
Mailing Address - Phone:512-705-0370
Mailing Address - Fax:
Practice Address - Street 1:513 HICKORY RUN DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3993
Practice Address - Country:US
Practice Address - Phone:512-954-4707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle