| NPI | 1255944559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE FERGESON Credentialing/ Office Administrator 479-777-8510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2020-08-26 |