| NPI | 1518597988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL LYNN BLANKENSHIP Lead Credentialing Specialist 304-429-1088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2020-01-24 |
| Last Update Date | 2023-12-20 |