| NPI | 1780156893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTA DANAE THOMPSON Owner 979-297-9086 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LA2200X Nurse Practitioner, Adult Health | |
| Enumeration Date | 2018-12-31 |
| Last Update Date | 2023-05-31 |