| NPI | 1598476681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AL BERRY Credentialing Manager 386-703-9084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-12-08 |
| Last Update Date | 2023-11-26 |