| NPI | 1528585577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI ANNE DYESS President 737-300-4013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| 374700000X Technician | |
| 101Y00000X Counselor | |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 163W00000X Registered Nurse | |
| 164W00000X Licensed Practical Nurse | |
| 164X00000X Licensed Vocational Nurse | |
| 171M00000X Case Manager/Care Coordinator | |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2021-05-26 |