| NPI | 1699030031 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA ANN WALDRON COO Rdinator 270-465-3561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| 363LF0000X Nurse Practitioner Family | |
| 363LP2300X Nurse Practitioner Primary Care | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2025-03-31 |