| NPI | 1871308056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE I PENN Manager/Provider 214-584-4103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-02-12 |
| Last Update Date | 2025-02-12 |