| NPI | 1326454448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY JO HAYNIE Owner 270-339-3783 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: KY 3005162) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2014-07-09 |