| NPI | 1770139941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODY A BARHAM Owner/Apn 870-773-1711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2019-08-14 |