| 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 |