| NPI | 1679971139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDEN A BLEDSOE Owner 502-895-7761 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2014-12-16 |