| NPI | 1861190555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CALLIE SHORT Owner 859-583-3842 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse |
| Enumeration Date | 2023-02-21 |
| Last Update Date | 2023-02-21 |