| NPI | 1902031602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANIE ISON Asst. Office Manager 606-678-8155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2012-12-04 |