NPI | 1053742643 |
---|---|
Entity Type | Organization |
Authorized Contact | LANCE A VICKERY Owner 816-500-0487 |
Organization Subpart ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 13-87373-111) |
Enumeration Date | 2013-12-06 |
Last Update Date | 2013-12-06 |