| NPI | 1720092240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM LOYD BUCK Practice Administrator 270-683-3232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 1041C0700X Social Worker Clinical | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 363A00000X Physician Assistant | |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0200X Nurse Practitioner Pediatrics | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2024-11-19 |