| NPI | 1902101124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD D. WILSON CFO 270-210-0399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2020-03-27 |