| NPI | 1669299889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLSIE FERGUSON GILLCOAT CEO / Nurse Practitioner 903-903-0903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2024-09-20 |
| Last Update Date | 2025-11-23 |