| NPI | 1528808268 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER STOUT Manager 337-315-7927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2024-12-04 |