| NPI | 1477176824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL ROSE WILSON Owner 901-292-2964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2020-11-18 |