| NPI | 1750892402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM SCOTT GIBSON Owner 502-504-1411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3009625) |
| Enumeration Date | 2017-10-21 |
| Last Update Date | 2023-11-09 |