| NPI | 1972867224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP RANDY MULLINS CEO 606-487-0776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2014-02-10 |