| NPI | 1013741420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACHELLE GRIFFIN Chief Human Resource Office 769-208-4437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-08-28 |
| Last Update Date | 2025-05-29 |