| NPI | 1902297625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE DENISE SIMMONS Manager/Owner 270-469-4496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner Women's Health (Licence: KY 3006407) |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2015-06-16 |