| NPI | 1841358876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNA STIVERS DAVE Member/Owner 502-593-0083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: KY 900263) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363A00000X Physician Assistant | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2015-11-27 |