| NPI | 1376188391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY SCOTT Owner 662-274-3212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2020-04-03 |