| NPI | 1881212348 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | JEREMY WAYNE CREEKMORE Owner 808-398-0537 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health | 
| Enumeration Date | 2020-07-10 | 
| Last Update Date | 2025-09-02 |