| NPI | 1639822828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JALEESA SHEARS Owner 870-559-9144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2022-01-28 |
| Last Update Date | 2024-02-24 |