| NPI | 1316736424 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA I RICKETTS Owner Of Entity 682-336-1943 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-05-05 |
| Last Update Date | 2025-05-05 |