| NPI | 1164096145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN D OSBORNE Owner 254-307-3997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2023-10-05 |