| NPI | 1063855450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEA NUNES-VAIS Cms 502-292-8973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine |
| 2080P0216X Pediatrics, Pediatric Rheumatology | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2023-06-28 |