| NPI | 1376584789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA M GIBSON COO 409-832-8338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207Q00000X Family Medicine | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2022-09-13 |