| NPI | 1174872139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAM DENISE BURNETT Manager Of Operations 731-984-9963 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2019-08-19 |