Organization Name: | LITTLE CLINIC OF IN LLC |
NPI Number: | 1558791384 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KENNETH W PATRIC (CHIEF LEGAL OFFICER) |
Mailing Address: | 815 Highlander Point Dr Floyds Knobs |
State: | IN US |
Postal Code: | 471199470 |
Phone Number: | 8129237146 |
Fax Number: | |
NPI Enumeration Date: | 11/14/2013 |
NPI Last Update Date: | 10/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |