| NPI | 1386614766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE BETH RAST Practice Administrator 903-785-4362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2021-09-22 |