| NPI | 1528725363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACY SMITH Ap RN 620-649-2505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| 363LF0000X Nurse Practitioner Family | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2021-11-29 |
| Last Update Date | 2024-12-03 |