| NPI | 1811596646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACK RAGSDALE Cred Account Manager 512-454-5911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology Addiction Medicine |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine |
| 207RA0401X Internal Medicine Addiction Medicine | |
| 2083A0300X Preventive Medicine Addiction Medicine | |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2020-10-22 |
| Last Update Date | 2025-04-07 |