Provider Demographics
NPI:1366200289
Name:PURIFOY, WAKEISHA
Entity type:Individual
Prefix:
First Name:WAKEISHA
Middle Name:
Last Name:PURIFOY
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 1:520 BIG LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8021
Mailing Address - Country:US
Mailing Address - Phone:469-876-9381
Mailing Address - Fax:
Practice Address - Street 1:1229 GRANADA DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8021
Practice Address - Country:US
Practice Address - Phone:469-876-9381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care