| NPI | 1083265284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY ALLISON BOWEN Owner 662-532-1543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2022-05-31 |