| NPI | 1033906219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENELLE CORINE FREEMAN Owner/Provider 463-215-7577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-04-22 |
| Last Update Date | 2025-04-22 |