| NPI | 1215984711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DJIEN SO Administrator 606-794-5600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: KY 900116) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3008377) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3007841) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2023-05-09 |