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 |