| NPI | 1720447659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI P GAGNE Ap RN 704-438-0687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC 20033) |
| Enumeration Date | 2016-02-20 |
| Last Update Date | 2021-11-22 |