| NPI | 1508057126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TABETHA LYNN SMITH Co Owner 910-763-1960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 200923) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 39512) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2007-08-08 |