| NPI | 1386876647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KANDI R REA Credentialing Specialist 606-330-3404 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2009-08-19 |
| Last Update Date | 2009-08-19 |