| NPI | 1922898113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA LUCKETT Provider 662-253-8543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 207Y00000X Otolaryngology |
| Enumeration Date | 2025-05-09 |
| Last Update Date | 2025-05-12 |