| NPI | 1679251821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIA D THOMAS Owner 318-317-1238 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care |
| Enumeration Date | 2023-07-07 |
| Last Update Date | 2023-07-07 |