| NPI | 1639836000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAWANA CHANELL RAYMOND Nurse Practitioner, Owner 228-641-2449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-11-19 |
| Last Update Date | 2024-04-18 |