| NPI | 1275149908 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN E WISLER Nurse Practitioner 270-217-2493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2020-09-18 |