| NPI | 1598124927 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAQUITA STARKS President 662-609-3092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2016-02-12 |