| NPI | 1699561779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAUL THOMAS Credentialing Manager 502-208-4070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2025-04-16 |
| Last Update Date | 2025-12-08 |