NPI | 1104540079 |
---|---|
Entity Type | Organization |
Authorized Contact | KRISTIE MICHELLE CLARK Owner 785-209-3779 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
Additional Taxonomies | 207Q00000X Family Medicine |
208000000X Pediatrics | |
2084P0800X Psychiatry & Neurology, Psychiatry | |
Enumeration Date | 2022-10-03 |
Last Update Date | 2025-02-12 |