| NPI | 1427478700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBYN B ANDERSON Billing/Credentialing Manager 270-366-0960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 39216) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3007339) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2019-10-08 |