| NPI | 1013161132 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN VICKERS Administrator 662-243-2435 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R798833) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2008-11-17 |