| NPI | 1396479697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTOPHER STEWART OLDHAM Owner 817-689-3369 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2022-08-29 |