NPI | 1275142390 |
---|---|
Entity Type | Organization |
Authorized Contact | LISA LALLIER BLACKWELDER Family Nurse Practitioner 903-641-2481 |
Organization Subpart ? | No |
Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
Enumeration Date | 2020-07-24 |
Last Update Date | 2022-02-01 |