| NPI | 1245709658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA BRANCH VINES Manager/Fnp 318-315-0574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2023-07-17 |