| NPI | 1538255948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEQUILA NORRIS Director Of Finance 270-858-6936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: KY 600081) |
| 207Q00000X Family Medicine (Licence: KY 600081) | |
| 207R00000X Internal Medicine (Licence: KY 600081) | |
| 208600000X Surgery (Licence: KY 600081) | |
| 363A00000X Physician Assistant | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 600081) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2024-06-10 |