| NPI | 1780080192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA KERR Enrollment 469-613-8343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2021-05-07 |