| NPI | 1518792365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHATRIENA D JOHNSON Pmhnp Bc 772-208-8734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2024-09-03 |