NPI | 1639617103 |
---|---|
Doing Business As | SPROUTS FAMILY & PEDIATRIC HEALTH CLINIC |
Entity Type | Organization |
Authorized Contact | JOANIE LYNN GRAVES Manager 318-310-5840 |
Organization Subpart ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics |
Enumeration Date | 2017-02-05 |
Last Update Date | 2025-06-19 |