| NPI | 1568105021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER OBANNON Owner/Pmhnp Bc 502-408-4977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2022-04-13 |