| NPI | 1962184341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRISTAR MBC Credentialing Manager 682-219-4077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-08-03 |
| Last Update Date | 2024-04-21 |