| NPI | 1558627158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA R DICKERSON Owner 256-232-0475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-093181) |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health (Licence: AL 1-093181) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2012-04-09 |