| NPI | 1770231656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDY FOUCH Owner 606-740-0986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363A00000X Physician Assistant | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| Enumeration Date | 2022-03-10 |
| Last Update Date | 2022-03-14 |