| NPI | 1386883007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA KAY CALLICOAT Np 903-737-8095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 610833) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: TX J1535) |
| Enumeration Date | 2009-02-19 |
| Last Update Date | 2010-12-21 |