| NPI | 1790113553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA FAYE KEAGLE Owner/Practitioner 931-854-0050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN ANP 16167) |
| Enumeration Date | 2013-10-14 |
| Last Update Date | 2014-03-06 |