| NPI | 1841373412 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ALLEN WALLINGFORD President 606-759-7615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 24430) |
| Additional Taxonomies | 208000000X Pediatrics |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2016-06-09 |