| NPI | 1528778628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AL BERRY Credentialing Manager 386-703-9084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult |
| Enumeration Date | 2022-11-29 |
| Last Update Date | 2022-12-05 |