| NPI | 1124614839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAMILAH J PAYNE Owner 346-442-6856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care |
| 207Q00000X Family Medicine | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2020-12-16 |
| Last Update Date | 2025-07-25 |