| NPI | 1972870053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY OWEN LOE Cfnp 601-825-3074 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R862120) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2011-12-20 |