| NPI | 1770338295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTY PAGE Owner 463-224-2641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2024-04-18 |
| Last Update Date | 2024-10-02 |