| NPI | 1205870862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENEACE CLEMONS COO 270-259-1626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| 207X00000X Orthopaedic Surgery | |
| 207Y00000X Otolaryngology | |
| 207QS0010X Family Medicine, Sports Medicine | |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| 208600000X Surgery | |
| 207Q00000X Family Medicine | |
| 208D00000X General Practice | |
| 231H00000X Audiologist | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-12-09 |