| NPI | 1356102537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK LETHERMON Nurse Practitioner 918-606-5225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-01-16 |
| Last Update Date | 2024-01-16 |