| NPI | 1093481251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER C BULLOCK President 662-534-2227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2025-08-20 |