| NPI | 1760905616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL S RANALLO Secretary 270-417-4813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family |
| Additional Taxonomies | 261QU0200X Clinic/Center Urgent Care |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2022-12-28 |