| NPI | 1659139749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA LATRICE ANDERSON Nurse Practitioner 870-329-4502 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| Enumeration Date | 2024-03-12 |
| Last Update Date | 2024-03-12 |