| NPI | 1972308450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AL BERRY Credentialing Manager 469-915-4211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-02-18 |
| Last Update Date | 2025-04-24 |