| NPI | 1144400607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY BRISTER Owner 662-226-0110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R875035) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS R742805) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2016-12-01 |