| NPI | 1497634042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLIE LYNDSY JOSE Nurse Practitioner 551-998-3674 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-08-28 |
| Last Update Date | 2026-01-30 |