| NPI | 1790442218 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CODY PITTMAN Practice Owner/Provider 502-457-8475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2023-01-29 |