| NPI | 1164176749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTONIO D. INGRAM CEO 903-417-5377 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QR1300X Clinic/Center, Rural Health | |
| Enumeration Date | 2022-02-11 |
| Last Update Date | 2022-02-11 |