| NPI | 1386461226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENA KAYE MONTGOMERY CEO 870-703-5022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2024-11-06 |