| NPI | 1740989581 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE ARMENTA Credentialing Specialist 228-334-6609 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2023-03-01 |
| Last Update Date | 2024-07-19 |