NPI | 1821085721 |
---|---|
Entity Type | Organization |
Authorized Contact | MICHAEL HENRY Owner 903-572-9823 |
Organization Subpart ? | No |
Primary Taxonomy | 208000000X Pediatrics |
Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
363LP0200X Nurse Practitioner, Pediatrics | |
Enumeration Date | 2005-10-05 |
Last Update Date | 2025-09-17 |