| NPI | 1154142305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELBY WINSCHEL Credentialing Manager 254-768-3397 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 208000000X Pediatrics |
| 363A00000X Physician Assistant | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2024-10-21 |
| Last Update Date | 2024-10-21 |