| NPI | 1275341042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER STOUT Manager 337-315-7927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2024-12-24 |
| Last Update Date | 2025-05-31 |