| NPI | 1699725234 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF D KINGERY Director 270-706-1900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical | |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2013-12-18 |