| NPI | 1417778432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE WALLACE Owner/Managing Member 985-251-2562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2024-10-22 |
| Last Update Date | 2025-10-29 |