| NPI | 1629800099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA SEWELL SHORT Owner 501-350-6785 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-08-15 |
| Last Update Date | 2024-08-15 |