| NPI | 1073970463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN LANGSTON Practice Manager 270-887-6767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: KY 39086) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: KY 3006456) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3008299) | |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2016-01-15 |