| NPI | 1760961908 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISTI LYNN Owner / Provider 931-636-6648 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM CNP-02392) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2018-12-06 |