| NPI | 1548988835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKY TUCKER Manager 417-413-1351 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2022-08-22 |