| NPI | 1003579913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NAKEITRA CURTIS Credentialing Manager 254-466-1749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QP2300X Clinic/Center, Primary Care | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2022-01-13 |