| NPI | 1831555143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY SMITH President 304-687-4204 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: KY 22964) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA1075) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3007017) | |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2022-10-03 |