| NPI | 1942176185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN GOUGH Owner 252-256-1692 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LW0102X Nurse Practitioner, Women's Health |
| Enumeration Date | 2025-10-15 |
| Last Update Date | 2025-10-15 |