NPI | 1982465084 |
---|---|
Entity Type | Organization |
Authorized Contact | ANGIE MATTINGLY Director Licensure And Enrollment 502-394-2100 |
Organization Subpart ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner |
Enumeration Date | 2024-01-17 |
Last Update Date | 2025-09-17 |