| NPI | 1447484118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACIE LYNN BULLOCK A RN P 270-534-4803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3142P) |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2010-07-21 |