| NPI | 1104537562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY BROOKE CANTRELL Credentialing Specialist 423-413-3832 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-12-07 |
| Last Update Date | 2022-12-12 |