| NPI | 1629640990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATONYA CARROLL Nurse Practitioner 877-318-0934 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2021-07-15 |