| NPI | 1417573270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANESSA LYLE Billing And Credential Specialist 667-212-3626 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2020-06-17 |