| NPI | 1104670884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH REED Owner 918-921-5701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2024-05-18 |