| NPI | 1194459719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY BACON Nurse Practitioner 620-249-4519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2022-07-11 |