| NPI | 1174322309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY JAMES BEACHAM Owner 502-515-4901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| Enumeration Date | 2025-03-11 |
| Last Update Date | 2025-04-23 |