| NPI | 1891145348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN G. BUMGARNER AO 866-456-7968 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K4821) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine |
| 207R00000X Internal Medicine (Licence: TX J6806) | |
| 2084P0805X Psychiatry & Neurology Geriatric Psychiatry | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2019-10-13 |