| NPI | 1417818733 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER MCQUAY Director Of Accounts 870-604-4455 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LC1500X Nurse Practitioner, Community Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-11-18 |
| Last Update Date | 2026-04-15 |