| NPI | 1114509379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASHUNTA CARSON Nurse Practitioner 682-410-3059 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2021-09-01 |