| NPI | 1457814501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KANISHER MONIQUE CALDWELL Ap RN/Owner 870-692-3157 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2019-04-06 |
| Last Update Date | 2022-07-08 |