| NPI | 1710545488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAMECA L HUDSON Chief Executive Officer 769-572-4009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2021-11-10 |