| NPI | 1124470166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONYA WALTERS Administrator 662-326-3500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 893145) |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2016-07-01 |