| NPI | 1164156188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEYSHA JONES Director 866-389-2727 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2023-11-22 |