| NPI | 1447769559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SYDNI CLEMMONS Credentialing Manager 901-351-1791 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 261Q00000X |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2017-09-21 |
| Last Update Date | 2021-10-15 |