| NPI | 1457096430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOIS A JOHNSON Fnp C, Pmhnp Bc 662-321-5529 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2022-05-03 |
| Last Update Date | 2022-09-20 |