| NPI | 1265496483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA PRUITT Administrator 270-765-5921 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2013-09-17 |