Provider Demographics
NPI:1447949615
Name:PUCKETT, DEJUANNA LASHAY
Entity type:Individual
Prefix:
First Name:DEJUANNA
Middle Name:LASHAY
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 N CENTRAL DR APT E104
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-1191
Mailing Address - Country:US
Mailing Address - Phone:575-665-8356
Mailing Address - Fax:
Practice Address - Street 1:3901 N CENTRAL DR APT E104
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-1191
Practice Address - Country:US
Practice Address - Phone:575-665-8356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty