| NPI | 1871026005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE C WILKERSON Credentialing 573-331-5583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2018-05-09 |