| NPI | 1396793196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA KING Director, Credentialing Enrollment 800-370-3651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2022-07-21 |