| NPI | 1376139469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD W POPE Member 225-270-8068 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2022-10-21 |