| NPI | 1669265815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE CORBO Ap RN, Owner 469-638-3162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 302R00000X Health Maintenance Organization |
| 261Q00000X Clinic/Center | |
| 261QE0002X Clinic/Center, Emergency Care | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QP3300X Clinic/Center, Pain | |
| Enumeration Date | 2025-05-28 |
| Last Update Date | 2025-11-03 |