| NPI | 1871757930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN T HACKBARTH Secretary 270-417-4813 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X (Licence: KY 740041) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2014-01-30 |