| NPI | 1245002070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY DAWN ERVIN Nurse Practitioner 903-634-7004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2023-10-25 |
| Last Update Date | 2024-02-17 |