| NPI | 1932082203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER STOUT Director 337-315-7927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2025-07-25 |
| Last Update Date | 2025-07-25 |