| NPI | 1972077063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY JO PICKLE KRISPIN Fnp/Owner 903-450-0710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2020-12-15 |