| NPI | 1073971792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE H HOUSTON Member 601-992-0004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R867447) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: MS R867447) |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2016-06-02 |