| NPI | 1376135301 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBEKAH GRAY Ap RN 479-200-7777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2021-04-26 |