Provider Demographics
NPI:1306493382
Name:WASKOM, KAYLEE (LVN)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:WASKOM
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 1:301 W HAWKINS PKWY APT 213
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-1819
Mailing Address - Country:US
Mailing Address - Phone:903-930-6156
Mailing Address - Fax:
Practice Address - Street 1:301 W HAWKINS PKWY APT 213
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-1819
Practice Address - Country:US
Practice Address - Phone:903-930-6156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315520164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse