| NPI | 1992227425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETHANNE FONDREN CARSON Pmhnp 409-720-8709 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: LA AP09425) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2023-07-15 |