| NPI | 1790433456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA ANN BREWER Authorized Official 918-716-9717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2022-03-11 |
| Last Update Date | 2025-07-13 |