| NPI | 1003520966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAKE HARRISON Owner 865-455-4817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine |
| Enumeration Date | 2023-01-05 |
| Last Update Date | 2023-01-05 |