| NPI | 1013464882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT A GRIMES Np C/Partner 662-284-8565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MS 14758) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 701122) |
| 363LF0000X Nurse Practitioner, Family (Licence: MS 16792) | |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2023-06-27 |