| NPI | 1306569546 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | KELLEE E PERRY Owner 765-251-3987 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine | 
| Additional Taxonomies | 363L00000X Nurse Practitioner | 
| Enumeration Date | 2022-09-22 | 
| Last Update Date | 2025-09-24 |