| NPI | 1679467237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN CARLISLE Chief Operating Officer 501-951-0781 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2025-06-06 |
| Last Update Date | 2025-10-17 |