| NPI | 1417366279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY L RALSTON Practice Administator 502-368-9561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: KY 3008801) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2014-08-06 |