Provider Demographics
NPI:1366227787
Name:GAGNON, ROBERT LESTER (LVN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LESTER
Last Name:GAGNON
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:MR
Other - First Name:BOBBY
Other - Middle Name:LESTER
Other - Last Name:GAGNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:216 PALMER ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4258
Mailing Address - Country:US
Mailing Address - Phone:830-928-1763
Mailing Address - Fax:
Practice Address - Street 1:216 PALMER ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4258
Practice Address - Country:US
Practice Address - Phone:830-928-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168706164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse