| NPI | 1720960479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GROVER GLENDON KERNS VP Of Finance 304-260-1443 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208800000X Urology |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2025-07-23 |
| Last Update Date | 2025-07-23 |