| NPI | 1619346111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER C BULLOCK President 662-534-2298 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2024-08-26 |