| NPI | 1174302947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ABIGAIL LYNN RICHARDSON Owner 681-204-5535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-09-21 |
| Last Update Date | 2023-09-21 |