| NPI | 1851166813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA C GAINES Owner 502-644-9162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2023-11-20 |
| Last Update Date | 2023-11-20 |