| NPI | 1366851552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGET RANDOLPH Nurse Practitioner 405-414-6002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA 230003) |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2014-08-13 |