| NPI | 1780267146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOE VAP General Manager 502-244-2420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2021-05-04 |