| NPI | 1700209566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA BRISCOE Contracting Specialist 918-893-9445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2014-01-30 |
| Last Update Date | 2016-04-29 |