| NPI | 1922892256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLISON HENNESSEY Authorized Official 304-276-9254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| Enumeration Date | 2025-04-09 |
| Last Update Date | 2025-04-09 |