| NPI | 1699945576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNETTE HANSEN KENNISON Owner 904-296-3113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP1117892) |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2008-03-06 |