| NPI | 1851348338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DJIEN HWAT SO Administrator 606-432-3221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health (Licence: KY 900119) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 42956) |
| 363LF0000X Nurse Practitioner Family (Licence: KY 3006127) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2019-03-27 |