| 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 |