| NPI | 1063895985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVONNE HERLINDA BRAXTON Managing Member 817-416-5698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2020-06-16 |