| NPI | 1801314455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA HENRY Credentialing Specialist 812-590-6936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 207Q00000X Family Medicine | |
| 261QU0200X Clinic/Center, Urgent Care | |
| 261QX0100X Clinic/Center, Occupational Medicine | |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2018-08-01 |