| NPI | 1558102228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY MOORE Member 479-225-5429 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2024-06-05 |
| Last Update Date | 2024-06-06 |