| NPI | 1275887580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKISHA A MCDANIEL Family Nurse Practitioner 870-739-8631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 17083) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2012-11-08 |