| NPI | 1235863218 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN R EASTRIDGE Owner/Authorized Official 270-403-9333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2024-04-18 |