| NPI | 1962574897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAMON L GATEWOOD Owner 502-532-7341 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 37028) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 3007904) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2014-06-05 |