| NPI | 1003286428 |
|---|---|
| Former Name | KELLY ANN BRISSENDEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA061613) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA061613) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 019160) | |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2023-03-22 |