| NPI | 1588158752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLOTTE BALLARD Owner 210-600-4105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP107832) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L1817) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP107832) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP107832) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2024-04-01 |