| NPI | 1730326109 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASEY M LEWIS Owner 502-215-5090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2017-10-26 |