| NPI | 1861099269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALTREY ANNE TYREE Owner, Provider 270-421-3397 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-10-08 |
| Last Update Date | 2025-02-19 |