| NPI | 1295461119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE KENNEDY-FOSTER Md 270-438-6622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 208000000X Pediatrics | |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2024-02-26 |