| NPI | 1265205553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARA NETHERTON Credentialing Agent 859-248-6415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 251S00000X |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2024-11-19 |