| NPI | 1457784126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE JENKINS VP 270-827-7118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0200X Nurse Practitioner Pediatrics | |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2020-11-17 |