| NPI | 1790460434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAENELLE GRACE Nurse Practitioner 256-482-6922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2023-06-20 |