| NPI | 1306373170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY CARSTARPHEN Owner/Provider 251-402-0450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN165081) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |