| NPI | 1063809523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA JESSIE Owner 270-432-2444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2018-03-17 |