| NPI | 1679243653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDRIA DAVIS Owner 870-898-4576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2024-11-18 |