| NPI | 1285045922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA WARREN Director Credentialing & Payor Enro 502-400-8480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2021-10-11 |