| NPI | 1164802542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY LUKETT Owner 270-240-2305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2018-02-05 |