| NPI | 1598541906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY DAWN MOORE Regional Contracting Director 888-830-6088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-09-01 |
| Last Update Date | 2023-09-01 |