| NPI | 1518840883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEREDITH A CHILDRESS Owner 903-914-2551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2025-07-25 |
| Last Update Date | 2025-09-22 |