NPI | 1578448163 |
---|---|
Entity Type | Organization |
Authorized Contact | TYLER STOUT Director 337-315-7927 |
Organization Subpart ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
Additional Taxonomies | 363L00000X Nurse Practitioner |
Enumeration Date | 2025-08-11 |
Last Update Date | 2025-08-11 |