| NPI | 1043814486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARCI L PORTIE Owner 337-508-2333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2020-11-25 |
| Last Update Date | 2021-09-01 |