| NPI | 1700733367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIDISH JOSE CEO 817-300-5457 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2026-03-12 |
| Last Update Date | 2026-03-12 |