| NPI | 1982296430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASHUNTA LATIA CARSON Ap RN 682-410-3059 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2022-11-18 |