| NPI | 1104366988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVE PROSSER Practice Manager 731-499-2319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN7205) |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2018-03-17 |