| NPI | 1396251682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MULLISSA MICHELLE CHILDRESS Member 615-600-0253 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV RN88172) |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2017-12-21 |