| NPI | 1053305524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY JO NALLEY Administrator 502-348-7554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| 207Q00000X Family Medicine | |
| 208000000X Pediatrics | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0200X Nurse Practitioner Pediatrics | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2019-10-29 |