| NPI | 1275054868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMERA CONLEY Credentialing 512-496-1159 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 101YP2500X Counselor, Professional | |
| 111N00000X Chiropractor | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2024-02-01 |