| NPI | 1629267315 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE NICOLE SOUTHARD President 606-340-8825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: KY 02809) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2010-06-03 |