| NPI | 1073275442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOLBY BLEDSOE Owner 725-577-8636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2021-10-12 |
| Last Update Date | 2021-10-13 |