| NPI | 1386505709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REESEY RUSSELL Owner 940-704-1700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2025-11-24 |
| Last Update Date | 2025-12-24 |