| NPI | 1942225461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKSON RHUDY Owner 888-700-6907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 156694-1205) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 5932534-4405) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-08-22 |