| NPI | 1184293862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYESHIA CHLOTIEL HALSELL RICHARDS Pediatric Physician Assistant 502-500-8955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2021-11-03 |