| NPI | 1659193092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH ANN RUTH DEFALCO-GIBBS Owner 865-888-5818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2024-10-28 |