| NPI | 1033454012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKEY D. KINZEY Sole Member/Owner 812-941-8635 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: IN 02000860A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2016-05-18 |