| NPI | 1679929285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE L ELLERBROOK Owner 731-285-4111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN 0000014756) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2016-09-01 |