| NPI | 1679310072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNATHAN THERON LARROQUETTE Certified Nurse Practitioner 985-247-1394 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-07-11 |
| Last Update Date | 2024-10-09 |