| NPI | 1609524172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENTRY DE CASTRO Nurse Practitioner 816-800-1308 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2022-10-19 |