| NPI | 1174822159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY MICHAEL JONES Owner 360-588-1460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA 10004470) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 00009893) |
| 207Q00000X Family Medicine (Licence: WA 00017410) | |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2012-03-01 |