| NPI | 1083146633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE M BERRY Offcie Manager 270-233-2024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3008378) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2017-04-03 |