| NPI | 1689251183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMONE NICOLA JACKSON Owner/ Provider 901-283-1975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2021-04-12 |