| NPI | 1306233572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM BRADFORD MCCORMICK CFO 318-214-4350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA 000000) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2020-06-26 |