| NPI | 1376286732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE NORTHAM Primary Operator 712-828-0234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2022-04-14 |