| NPI | 1417847773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATRINA SMITH Cred Mgr 855-276-5212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2025-07-08 |
| Last Update Date | 2025-07-15 |