| NPI | 1679914733 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD D BASHAM Owner 270-971-1388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: KY 3007397) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2021-05-21 |