| NPI | 1013578954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGGIE DARNELL PENNYPACKER Nurse Practitioner 580-656-6661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2024-08-26 |