| NPI | 1558242255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMIE D NIEMER Credentialing Manager 606-408-9565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2025-09-09 |
| Last Update Date | 2025-10-31 |