| NPI | 1942073317 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE DENISE O'DONNELL Medical Director/Owner 903-390-1790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2023-11-06 |