| NPI | 1770213928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNA SHACKELFORD Ap RN, Pmhnp 901-300-6808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-06-11 |
| Last Update Date | 2023-09-19 |