| NPI | 1316322027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRANCE DILLON Assistant Secretary 502-596-7220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207RX0202X Internal Medicine, Medical Oncology |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2022-04-25 |