| NPI | 1477371557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMICKY TACHELL DAVIS Pmhnp 502-403-4365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2024-09-28 |
| Last Update Date | 2024-09-28 |