| NPI | 1083124671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONIQUE CASEY-BOLDEN President 731-288-0911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD35727) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD25289) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN APN13637) | |
| Enumeration Date | 2017-10-09 |
| Last Update Date | 2017-10-09 |