| NPI | 1972104610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASMINE SHANAE HYPOLITE-KING Owner 405-439-5849 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2020-11-07 |
| Last Update Date | 2023-09-14 |