Provider Demographics
NPI:1386399350
Name:DOVE-AUSTIN, DARRIAN (LVN)
Entity type:Individual
Prefix:
First Name:DARRIAN
Middle Name:
Last Name:DOVE-AUSTIN
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6174 SUE ANN LN
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75161-8145
Mailing Address - Country:US
Mailing Address - Phone:214-449-5063
Mailing Address - Fax:
Practice Address - Street 1:6174 SUE ANN LN
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75161-8145
Practice Address - Country:US
Practice Address - Phone:214-449-5063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338319164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty