| NPI | 1659554079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA R TUCKER Office Manager 270-527-2273 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 4072P) |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2007-12-07 |