| NPI | 1801221239 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWANA L MCKISSACK Credentialing Specialist 615-482-4879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 15063) |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2013-09-04 |